Provider Demographics
NPI:1144758145
Name:MERRELL, JOSHUA LOGAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOSHUA
Middle Name:LOGAN
Last Name:MERRELL
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 340
Mailing Address - Street 2:
Mailing Address - City:WHITEFISH
Mailing Address - State:MT
Mailing Address - Zip Code:59937-0340
Mailing Address - Country:US
Mailing Address - Phone:406-862-3839
Mailing Address - Fax:
Practice Address - Street 1:3000 HOSPITAL WAY
Practice Address - Street 2:
Practice Address - City:WHITEFISH
Practice Address - State:MT
Practice Address - Zip Code:59937-7838
Practice Address - Country:US
Practice Address - Phone:406-862-3839
Practice Address - Fax:406-862-1428
Is Sole Proprietor?:No
Enumeration Date:2017-06-02
Last Update Date:2017-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTDEN-DEN-LIC-134371223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice