Provider Demographics
NPI:1508356916
Name:MERIT DENTAL GROUP
Entity Type:Organization
Organization Name:MERIT DENTAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:
Authorized Official - Last Name:DELOACH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:801-201-9589
Mailing Address - Street 1:PO BOX 310
Mailing Address - Street 2:
Mailing Address - City:DELTA
Mailing Address - State:UT
Mailing Address - Zip Code:84624-0310
Mailing Address - Country:US
Mailing Address - Phone:801-201-9589
Mailing Address - Fax:
Practice Address - Street 1:60 S 300 E
Practice Address - Street 2:
Practice Address - City:DELTA
Practice Address - State:UT
Practice Address - Zip Code:84624-5551
Practice Address - Country:US
Practice Address - Phone:435-864-5195
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-11
Last Update Date:2018-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental