Provider Demographics
NPI:1154834059
Name:MERRIN, MARIA (RDH)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:
Last Name:MERRIN
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:MARIA
Other - Middle Name:
Other - Last Name:TSAGRIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RDH
Mailing Address - Street 1:725 S HUALAPAI WAY APT 2002
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89145-8838
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:725 S HUALAPAI WAY APT 2002
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89145-8838
Practice Address - Country:US
Practice Address - Phone:310-704-3136
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-14
Last Update Date:2017-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV13102124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist