Provider Demographics
NPI:1023476314
Name:MERIT DENTAL INC
Entity type:Organization
Organization Name:MERIT DENTAL INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PC OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:MOOS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:715-926-5050
Mailing Address - Street 1:155 E MARKET ST
Mailing Address - Street 2:STE 3
Mailing Address - City:BLAIRSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15717-1357
Mailing Address - Country:US
Mailing Address - Phone:724-459-6240
Mailing Address - Fax:724-459-0639
Practice Address - Street 1:155 E MARKET ST
Practice Address - Street 2:STE 3
Practice Address - City:BLAIRSVILLE
Practice Address - State:PA
Practice Address - Zip Code:15717-1357
Practice Address - Country:US
Practice Address - Phone:724-459-6240
Practice Address - Fax:724-459-0639
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-02
Last Update Date:2016-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty