Provider Demographics
NPI:1770650756
Name:MERKELBACH, RICHARD COLLINS (DDS)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:COLLINS
Last Name:MERKELBACH
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:80 STONEHOUSE RD
Mailing Address - Street 2:
Mailing Address - City:GLEN RIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07028-1718
Mailing Address - Country:US
Mailing Address - Phone:973-783-1571
Mailing Address - Fax:
Practice Address - Street 1:290 BROAD ST
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07003-2746
Practice Address - Country:US
Practice Address - Phone:973-743-2123
Practice Address - Fax:973-743-0042
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ81061223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice