Provider Demographics
NPI:1548587819
Name:MERRILL, JOHN FREEMAN (LD)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:FREEMAN
Last Name:MERRILL
Suffix:
Gender:M
Credentials:LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 107
Mailing Address - Street 2:
Mailing Address - City:ETNA
Mailing Address - State:ME
Mailing Address - Zip Code:04434-0107
Mailing Address - Country:US
Mailing Address - Phone:207-269-4570
Mailing Address - Fax:
Practice Address - Street 1:1075 STAGE RD
Practice Address - Street 2:
Practice Address - City:ETNA
Practice Address - State:ME
Practice Address - Zip Code:04434
Practice Address - Country:US
Practice Address - Phone:207-269-4570
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-27
Last Update Date:2010-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME5012122400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122400000XDental ProvidersDenturist