Provider Demographics
NPI:1851876445
Name:MERIT DENTAL INC
Entity Type:Organization
Organization Name:MERIT DENTAL INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR, PAYER STRATEGY
Authorized Official - Prefix:
Authorized Official - First Name:CHAD
Authorized Official - Middle Name:
Authorized Official - Last Name:HENDRICKS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-351-6876
Mailing Address - Street 1:680 HEHLI WAY
Mailing Address - Street 2:
Mailing Address - City:MONDOVI
Mailing Address - State:WI
Mailing Address - Zip Code:54755-1639
Mailing Address - Country:US
Mailing Address - Phone:715-598-2311
Mailing Address - Fax:715-350-6855
Practice Address - Street 1:343 W 10TH ST
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16502-1491
Practice Address - Country:US
Practice Address - Phone:814-464-0960
Practice Address - Fax:814-464-0969
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-28
Last Update Date:2018-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty