Provider Demographics
NPI:1407829138
Name:MERRITHEW, JASON M (DDS)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:M
Last Name:MERRITHEW
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5217 N ROYAL DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49684-6985
Mailing Address - Country:US
Mailing Address - Phone:231-929-3606
Mailing Address - Fax:231-929-0610
Practice Address - Street 1:5217 N ROYAL DR
Practice Address - Street 2:SUITE A
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49684-6985
Practice Address - Country:US
Practice Address - Phone:231-929-3606
Practice Address - Fax:231-929-0610
Is Sole Proprietor?:No
Enumeration Date:2006-02-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI18899122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist