Provider Demographics
NPI:1740696228
Name:MERRITT, HEIDI REBECCA (DDS)
Entity type:Individual
Prefix:
First Name:HEIDI
Middle Name:REBECCA
Last Name:MERRITT
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:95 VIRGINIA ST
Mailing Address - Street 2:
Mailing Address - City:PONTIAC
Mailing Address - State:MI
Mailing Address - Zip Code:48342-1375
Mailing Address - Country:US
Mailing Address - Phone:248-212-6017
Mailing Address - Fax:
Practice Address - Street 1:1010 N CAMPBELL RD
Practice Address - Street 2:
Practice Address - City:ROYAL OAK
Practice Address - State:MI
Practice Address - Zip Code:48067-1570
Practice Address - Country:US
Practice Address - Phone:248-542-9700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-07
Last Update Date:2014-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010213181223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice