Provider Demographics
NPI:1245893601
Name:JOSHUA MERRELL, DDS, PLLC
Entity type:Organization
Organization Name:JOSHUA MERRELL, DDS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOSHUA
Authorized Official - Middle Name:LOGAN
Authorized Official - Last Name:MERRELL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:201-919-1426
Mailing Address - Street 1:5024 LACEY BLVD SE
Mailing Address - Street 2:
Mailing Address - City:LACEY
Mailing Address - State:WA
Mailing Address - Zip Code:98503-5729
Mailing Address - Country:US
Mailing Address - Phone:201-919-1426
Mailing Address - Fax:
Practice Address - Street 1:501 TYEE DR SW
Practice Address - Street 2:
Practice Address - City:TUMWATER
Practice Address - State:WA
Practice Address - Zip Code:98512-7313
Practice Address - Country:US
Practice Address - Phone:201-919-1426
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-20
Last Update Date:2024-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental