Provider Demographics
NPI:1164455234
Name:MERELLO, DAVID L (DDS, PC)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:L
Last Name:MERELLO
Suffix:
Gender:M
Credentials:DDS, PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2135 N STATE RT 7
Mailing Address - Street 2:
Mailing Address - City:PLEASANT HILL
Mailing Address - State:MO
Mailing Address - Zip Code:64080
Mailing Address - Country:US
Mailing Address - Phone:816-540-2143
Mailing Address - Fax:
Practice Address - Street 1:12508 WINCHESTER AVE
Practice Address - Street 2:
Practice Address - City:GRANDVIEW
Practice Address - State:MO
Practice Address - Zip Code:64030-2059
Practice Address - Country:US
Practice Address - Phone:816-761-9343
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOMO 12663122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist