Provider Demographics
NPI:1841750437
Name:MERKLEY PROFESSIONALS, INC
Entity Type:Organization
Organization Name:MERKLEY PROFESSIONALS, INC
Other - Org Name:DR. KVITKO & ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:AGENT
Authorized Official - Prefix:
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 1:19 W MARKET ST STE A
Mailing Address - Street 2:
Mailing Address - City:TIFFIN
Mailing Address - State:OH
Mailing Address - Zip Code:44883-2772
Mailing Address - Country:US
Mailing Address - Phone:419-447-9541
Mailing Address - Fax:419-447-1223
Practice Address - Street 1:19 W MARKET ST STE A
Practice Address - Street 2:
Practice Address - City:TIFFIN
Practice Address - State:OH
Practice Address - Zip Code:44883-2772
Practice Address - Country:US
Practice Address - Phone:419-447-9541
Practice Address - Fax:419-447-1223
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MERKLEY MIDWEST - OHIO, P.A.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-03-21
Last Update Date:2023-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
No122300000XDental ProvidersDentistGroup - Single Specialty