Provider Demographics
NPI:1164723763
Name:JOSHUA D. MERRILL, DDS, LLC
Entity Type:Organization
Organization Name:JOSHUA D. MERRILL, DDS, LLC
Other - Org Name:NEW LONDON DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSHUA
Authorized Official - Middle Name:D
Authorized Official - Last Name:MERRILL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:419-929-1544
Mailing Address - Street 1:63 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:NEW LONDON
Mailing Address - State:OH
Mailing Address - Zip Code:44851-1233
Mailing Address - Country:US
Mailing Address - Phone:419-929-1544
Mailing Address - Fax:419-929-0402
Practice Address - Street 1:63 E MAIN ST
Practice Address - Street 2:
Practice Address - City:NEW LONDON
Practice Address - State:OH
Practice Address - Zip Code:44851-1233
Practice Address - Country:US
Practice Address - Phone:419-929-1544
Practice Address - Fax:419-929-0402
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-12
Last Update Date:2010-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30022573122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1952508855OtherNPI