Provider Demographics
NPI:1265025431
Name:MERIGOLD, JOANNE (RDH)
Entity Type:Individual
Prefix:
First Name:JOANNE
Middle Name:
Last Name:MERIGOLD
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6628 CABOT DR
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37209-4311
Mailing Address - Country:US
Mailing Address - Phone:630-390-0064
Mailing Address - Fax:
Practice Address - Street 1:2125 BLAKEMORE AVE
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37212-3505
Practice Address - Country:US
Practice Address - Phone:615-383-3690
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-18
Last Update Date:2021-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN9540124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist