Provider Demographics
NPI:1184938185
Name:MERRITT, PAMELA JEAN (DDS, PC)
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:JEAN
Last Name:MERRITT
Suffix:
Gender:F
Credentials:DDS, PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2022 BRAMBLETON AVE SW
Mailing Address - Street 2:PAMELA J MERRITT DDS PC
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24015
Mailing Address - Country:US
Mailing Address - Phone:540-342-8588
Mailing Address - Fax:540-342-7301
Practice Address - Street 1:2022 BRAMBLETON AVE SW
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24015
Practice Address - Country:US
Practice Address - Phone:540-342-8588
Practice Address - Fax:540-342-7301
Is Sole Proprietor?:No
Enumeration Date:2010-08-02
Last Update Date:2010-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401006459122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist