Provider Demographics
NPI:1568512655
Name:FULL SERVICE DENTAL HEALTH P.C.
Entity Type:Organization
Organization Name:FULL SERVICE DENTAL HEALTH P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:RAFFI
Authorized Official - Middle Name:
Authorized Official - Last Name:MERJIK
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:508-587-5333
Mailing Address - Street 1:200 WESTGATE DR STE 2
Mailing Address - Street 2:
Mailing Address - City:BROCKTON
Mailing Address - State:MA
Mailing Address - Zip Code:02301-1810
Mailing Address - Country:US
Mailing Address - Phone:508-587-5333
Mailing Address - Fax:508-584-5017
Practice Address - Street 1:200 WESTGATE DR STE 2
Practice Address - Street 2:
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02301-1810
Practice Address - Country:US
Practice Address - Phone:508-587-5333
Practice Address - Fax:508-584-5017
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA200011223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA9709321Medicare ID - Type UnspecifiedPRACTICE GROUP NUMBER