Provider Demographics
NPI:1841213360
Name:MERRILL, PHILLIP HUDSON (DMD)
Entity Type:Individual
Prefix:DR
First Name:PHILLIP
Middle Name:HUDSON
Last Name:MERRILL
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 1:2431 W MAIN ST
Mailing Address - Street 2:SUITE 701
Mailing Address - City:DOTHAN
Mailing Address - State:AL
Mailing Address - Zip Code:36301-1201
Mailing Address - Country:US
Mailing Address - Phone:334-793-9467
Mailing Address - Fax:
Practice Address - Street 1:2431 W MAIN ST
Practice Address - Street 2:SUITE 701
Practice Address - City:DOTHAN
Practice Address - State:AL
Practice Address - Zip Code:36301-1201
Practice Address - Country:US
Practice Address - Phone:334-793-9467
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL31101223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL90-3110Medicare ID - Type Unspecified
510-94686Medicare UPIN