Provider Demographics
NPI:1265665350
Name:MERRY DENTAL CARE CENTER, PA
Entity Type:Organization
Organization Name:MERRY DENTAL CARE CENTER, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEAN
Authorized Official - Middle Name:WORSING
Authorized Official - Last Name:MERRY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:952-942-0808
Mailing Address - Street 1:7460 MARKET PLACE DR
Mailing Address - Street 2:
Mailing Address - City:EDEN PRAIRIE
Mailing Address - State:MN
Mailing Address - Zip Code:55344-3604
Mailing Address - Country:US
Mailing Address - Phone:952-942-0808
Mailing Address - Fax:952-942-5151
Practice Address - Street 1:7460 MARKET PLACE DR
Practice Address - Street 2:
Practice Address - City:EDEN PRAIRIE
Practice Address - State:MN
Practice Address - Zip Code:55344-3604
Practice Address - Country:US
Practice Address - Phone:952-942-0808
Practice Address - Fax:952-942-5151
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-24
Last Update Date:2009-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN96161223G0001X
MND126971223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty