Provider Demographics
NPI:1255350260
Name:MERRELL, CHADWICK THOMAS (DMD)
Entity type:Individual
Prefix:DR
First Name:CHADWICK
Middle Name:THOMAS
Last Name:MERRELL
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2516 OAKCREST AVE STE A
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27408-1933
Mailing Address - Country:US
Mailing Address - Phone:336-282-4022
Mailing Address - Fax:336-282-2437
Practice Address - Street 1:2516 OAKCREST AVE STE A
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27408-1933
Practice Address - Country:US
Practice Address - Phone:336-282-4022
Practice Address - Fax:336-282-2437
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2024-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7539122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist