Provider Demographics
NPI:1013507391
Name:MERRILL RANCH FAMILY DENTAL, PLLC
Entity type:Organization
Organization Name:MERRILL RANCH FAMILY DENTAL, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:LAUREN
Authorized Official - Last Name:HERR
Authorized Official - Suffix:JR
Authorized Official - Credentials:DDS
Authorized Official - Phone:520-723-0655
Mailing Address - Street 1:3385 N HUNT HWY STE 127
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:AZ
Mailing Address - Zip Code:85132-6922
Mailing Address - Country:US
Mailing Address - Phone:520-723-0655
Mailing Address - Fax:520-723-0691
Practice Address - Street 1:3385 N HUNT HWY STE 127
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:AZ
Practice Address - Zip Code:85132-6922
Practice Address - Country:US
Practice Address - Phone:520-723-0655
Practice Address - Fax:520-723-0691
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-21
Last Update Date:2021-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental