Provider Demographics
NPI:1851403901
Name:MERJIK, GALINA (DMD)
Entity Type:Individual
Prefix:
First Name:GALINA
Middle Name:
Last Name:MERJIK
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:610 W BOYLSTON ST
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01606-2030
Mailing Address - Country:US
Mailing Address - Phone:508-853-3394
Mailing Address - Fax:508-853-6842
Practice Address - Street 1:610 W BOYLSTON ST
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01606-2030
Practice Address - Country:US
Practice Address - Phone:508-853-3394
Practice Address - Fax:508-853-6842
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2012-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA20013122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0297950Medicaid