Provider Demographics
NPI:1265709398
Name:MERKEL, HANSEN & FORD PLLC
Entity type:Organization
Organization Name:MERKEL, HANSEN & FORD PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JUSTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:HANSEN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:206-948-8427
Mailing Address - Street 1:10700 SE 174TH ST
Mailing Address - Street 2:SUITE 202
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98055-5472
Mailing Address - Country:US
Mailing Address - Phone:425-228-3420
Mailing Address - Fax:
Practice Address - Street 1:10700 SE 174TH ST
Practice Address - Street 2:SUITE 202
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98055-5472
Practice Address - Country:US
Practice Address - Phone:425-228-3420
Practice Address - Fax:425-228-3773
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-17
Last Update Date:2016-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE601695841223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty