Provider Demographics
NPI:1811349913
Name:MERRILL, STEPHEN WYLIE (DMD)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:WYLIE
Last Name:MERRILL
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3317 COUNTRY CLUB DR
Mailing Address - Street 2:
Mailing Address - City:LYNN HAVEN
Mailing Address - State:FL
Mailing Address - Zip Code:32444-5130
Mailing Address - Country:US
Mailing Address - Phone:850-832-0857
Mailing Address - Fax:
Practice Address - Street 1:10 BURTON HILLS BLVD
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37215-6105
Practice Address - Country:US
Practice Address - Phone:615-263-3854
Practice Address - Fax:615-565-9981
Is Sole Proprietor?:No
Enumeration Date:2016-07-13
Last Update Date:2016-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN10576122300000X
OH30022972122300000X
TNDS4308122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist