Provider Demographics
NPI:1093173395
Name:MERIT DENTAL INC
Entity Type:Organization
Organization Name:MERIT DENTAL INC
Other - Org Name:MERIT DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PC OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:MOOS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:715-926-5050
Mailing Address - Street 1:21 BALDWIN BLVD
Mailing Address - Street 2:
Mailing Address - City:SHAMOKIN DAM
Mailing Address - State:PA
Mailing Address - Zip Code:17876-9514
Mailing Address - Country:US
Mailing Address - Phone:570-743-3300
Mailing Address - Fax:570-743-7555
Practice Address - Street 1:21 BALDWIN BLVD
Practice Address - Street 2:
Practice Address - City:SHAMOKIN DAM
Practice Address - State:PA
Practice Address - Zip Code:17876-9514
Practice Address - Country:US
Practice Address - Phone:570-743-3300
Practice Address - Fax:570-743-7555
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-02
Last Update Date:2016-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty