Provider Demographics
NPI:1659894780
Name:MERIT DENTAL II - MICHIGAN, PC
Entity Type:Organization
Organization Name:MERIT DENTAL II - MICHIGAN, PC
Other - Org Name:MERIT DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR, PAYER STRATEGY
Authorized Official - Prefix:
Authorized Official - First Name:CHAD
Authorized Official - Middle Name:
Authorized Official - Last Name:HENDRICKS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-351-6876
Mailing Address - Street 1:680 HEHLI WAY
Mailing Address - Street 2:
Mailing Address - City:MONDOVI
Mailing Address - State:WI
Mailing Address - Zip Code:54755-1639
Mailing Address - Country:US
Mailing Address - Phone:715-598-2311
Mailing Address - Fax:715-350-6855
Practice Address - Street 1:4189 HIGHLAND RD
Practice Address - Street 2:
Practice Address - City:WATERFORD
Practice Address - State:MI
Practice Address - Zip Code:48328-2136
Practice Address - Country:US
Practice Address - Phone:248-682-9653
Practice Address - Fax:248-682-9266
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-20
Last Update Date:2017-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty