Provider Demographics
NPI:1922138312
Name:MERWIN, DANIEL R (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:R
Last Name:MERWIN
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:32 TANGER LAKE CV
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:TN
Mailing Address - Zip Code:38305-7375
Mailing Address - Country:US
Mailing Address - Phone:731-668-8922
Mailing Address - Fax:731-668-2755
Practice Address - Street 1:460 N PARKWAY
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38305-2818
Practice Address - Country:US
Practice Address - Phone:731-668-8922
Practice Address - Fax:731-668-2755
Is Sole Proprietor?:No
Enumeration Date:2007-03-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS00000070901223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics