Provider Demographics
NPI:1437575107
Name:LUCAS W. MERRELL, DDS, PA
Entity Type:Organization
Organization Name:LUCAS W. MERRELL, DDS, PA
Other - Org Name:MERRELL FAMILY DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:LUCAS
Authorized Official - Middle Name:WEST
Authorized Official - Last Name:MERRELL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:704-857-6161
Mailing Address - Street 1:702 S HIGHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:LANDIS
Mailing Address - State:NC
Mailing Address - Zip Code:28088-1706
Mailing Address - Country:US
Mailing Address - Phone:704-857-6161
Mailing Address - Fax:704-856-1847
Practice Address - Street 1:702 S HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:LANDIS
Practice Address - State:NC
Practice Address - Zip Code:28088-1706
Practice Address - Country:US
Practice Address - Phone:704-857-6161
Practice Address - Fax:704-856-1847
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-05
Last Update Date:2014-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty