Provider Demographics
NPI:1609508522
Name:MERKLEY MIDWEST - OHIO TOLEDO I INC
Entity Type:Organization
Organization Name:MERKLEY MIDWEST - OHIO TOLEDO I INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AGENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:
Authorized Official - Last Name:WALKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-550-6421
Mailing Address - Street 1:3951 W SYLVANIA AVE
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43623-4426
Mailing Address - Country:US
Mailing Address - Phone:419-475-6673
Mailing Address - Fax:
Practice Address - Street 1:3951 W SYLVANIA AVE
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43623-4426
Practice Address - Country:US
Practice Address - Phone:419-475-6673
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MERKLEY MIDWEST - OHIO, P.A.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-06-29
Last Update Date:2022-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty