Provider Demographics
NPI:1760802102
Name:MERRITT PERIODONTICS P.C.
Entity Type:Organization
Organization Name:MERRITT PERIODONTICS P.C.
Other - Org Name:ASSOCIATES IN PERIODONTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:R
Authorized Official - Last Name:MERRITT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:970-221-5050
Mailing Address - Street 1:1120 EAST ELIZABETH STREET
Mailing Address - Street 2:SUITE G5
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80524-4044
Mailing Address - Country:US
Mailing Address - Phone:970-221-5050
Mailing Address - Fax:970-221-5054
Practice Address - Street 1:1120 EAST ELIZABETH STREET
Practice Address - Street 2:SUITE G5
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80524-4044
Practice Address - Country:US
Practice Address - Phone:970-221-5050
Practice Address - Fax:970-221-5054
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-24
Last Update Date:2019-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO87861223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO9625OtherCOLORADO DENTAL LICENSE DR. MERRITT
CO8786OtherCOLORADO DENTAL LICENSE DR. JOHNSON