Provider Demographics
NPI:1245428283
Name:MERRITT, ROBERT SPANN (DMD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:SPANN
Last Name:MERRITT
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4610 OLEANDER DR
Mailing Address - Street 2:SUITE103
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29577-5752
Mailing Address - Country:US
Mailing Address - Phone:843-449-7114
Mailing Address - Fax:
Practice Address - Street 1:4610 OLEANDER DR
Practice Address - Street 2:SUITE103
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29577-5752
Practice Address - Country:US
Practice Address - Phone:843-449-7114
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-03
Last Update Date:2007-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4131122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist