Provider Demographics
NPI:1174008494
Name:JERRY D MERRELL, DDS INC
Entity Type:Organization
Organization Name:JERRY D MERRELL, DDS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:D
Authorized Official - Last Name:MERRELL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, INC
Authorized Official - Phone:805-688-1155
Mailing Address - Street 1:2028 VILLAGE LN STE 101
Mailing Address - Street 2:
Mailing Address - City:SOLVANG
Mailing Address - State:CA
Mailing Address - Zip Code:93463-3222
Mailing Address - Country:US
Mailing Address - Phone:805-688-1155
Mailing Address - Fax:805-686-2699
Practice Address - Street 1:2028 VILLAGE LN STE 101
Practice Address - Street 2:
Practice Address - City:SOLVANG
Practice Address - State:CA
Practice Address - Zip Code:93463-3222
Practice Address - Country:US
Practice Address - Phone:805-688-1155
Practice Address - Fax:805-686-2699
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-02
Last Update Date:2018-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty