Provider Demographics
NPI:1225432172
Name:AXPM - MERKLEY, LLC
Entity Type:Organization
Organization Name:AXPM - MERKLEY, LLC
Other - Org Name:SOUTHEAST SMILES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MERRITT
Authorized Official - Middle Name:
Authorized Official - Last Name:DAKE
Authorized Official - Suffix:
Authorized Official - Credentials:CPA
Authorized Official - Phone:501-781-2777
Mailing Address - Street 1:5100 TALLEY ROAD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72204
Mailing Address - Country:US
Mailing Address - Phone:501-781-2777
Mailing Address - Fax:501-781-2778
Practice Address - Street 1:2116 MEGAN DR.
Practice Address - Street 2:SUITE 101
Practice Address - City:CAPE GIRARDEAU
Practice Address - State:MO
Practice Address - Zip Code:63701
Practice Address - Country:US
Practice Address - Phone:573-296-2898
Practice Address - Fax:573-349-4391
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-21
Last Update Date:2014-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty