Provider Demographics
NPI:1295892115
Name:JEFFREY V. MERRIFIELD, D.D.S., INC.
Entity type:Organization
Organization Name:JEFFREY V. MERRIFIELD, D.D.S., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESTREAS
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFF
Authorized Official - Middle Name:
Authorized Official - Last Name:MERRIFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:408-849-5333
Mailing Address - Street 1:2664 BERRYESSA RD STE 116
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95132-2906
Mailing Address - Country:US
Mailing Address - Phone:408-849-5333
Mailing Address - Fax:408-929-5780
Practice Address - Street 1:2664 BERRYESSA RD STE 116
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95132-2906
Practice Address - Country:US
Practice Address - Phone:408-849-5333
Practice Address - Fax:408-929-5780
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA187361223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA18736OtherSTATE DENTAL LICENSE