Provider Demographics
NPI:1437561560
Name:MERZON, DMITRY GRIGORY (DMD)
Entity Type:Individual
Prefix:DR
First Name:DMITRY
Middle Name:GRIGORY
Last Name:MERZON
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 1:1751 MASSACHUSETTS AVE FL 1
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02140-2218
Mailing Address - Country:US
Mailing Address - Phone:617-207-8667
Mailing Address - Fax:
Practice Address - Street 1:1751 MASSACHUSETTS AVE FL 1
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02140-2218
Practice Address - Country:US
Practice Address - Phone:617-855-9092
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-23
Last Update Date:2018-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN1856532122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist