Provider Demographics
NPI:1407115801
Name:MERRITT DENTAL CARE LLC
Entity Type:Organization
Organization Name:MERRITT DENTAL CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PRASANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:RAVURI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:551-404-1207
Mailing Address - Street 1:399 MAIN AVE
Mailing Address - Street 2:#622
Mailing Address - City:NORWALK
Mailing Address - State:CT
Mailing Address - Zip Code:06851-1554
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:399 MAIN AVE
Practice Address - Street 2:#622
Practice Address - City:NORWALK
Practice Address - State:CT
Practice Address - Zip Code:06851-1554
Practice Address - Country:US
Practice Address - Phone:551-404-1207
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-07
Last Update Date:2012-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0102781223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty