Provider Demographics
NPI:1649427089
Name:TINA S. MERHOFF, DDS, PA
Entity type:Organization
Organization Name:TINA S. MERHOFF, DDS, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TINA
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:MERHOFF
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:336-659-9500
Mailing Address - Street 1:185 KIMEL PARK DR
Mailing Address - Street 2:SUITE 202
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-6973
Mailing Address - Country:US
Mailing Address - Phone:336-659-9500
Mailing Address - Fax:336-714-1017
Practice Address - Street 1:185 KIMEL PARK DR
Practice Address - Street 2:SUITE 202
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-6973
Practice Address - Country:US
Practice Address - Phone:336-659-9500
Practice Address - Fax:336-714-1017
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-27
Last Update Date:2008-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC8628122300000X
NC75951223P0221X
NC85521223P0221X
NC67471223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty
No122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89003TMedicaid