Provider Demographics
NPI:1841201308
Name:MERRELL, STEPHEN P (DMD)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:P
Last Name:MERRELL
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3188 W MONTAGUE AVE
Mailing Address - Street 2:
Mailing Address - City:N CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29418-5935
Mailing Address - Country:US
Mailing Address - Phone:843-554-3300
Mailing Address - Fax:843-554-0333
Practice Address - Street 1:3188 W MONTAGUE AVE
Practice Address - Street 2:
Practice Address - City:N CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29418-5935
Practice Address - Country:US
Practice Address - Phone:843-554-3300
Practice Address - Fax:843-554-0333
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2010-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCSC45561223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice