Provider Demographics
NPI:1912684200
Name:MERRITT, DAWN
Entity Type:Individual
Prefix:
First Name:DAWN
Middle Name:
Last Name:MERRITT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9588 CEMETERY RD
Mailing Address - Street 2:
Mailing Address - City:DE GRAFF
Mailing Address - State:OH
Mailing Address - Zip Code:43318-9547
Mailing Address - Country:US
Mailing Address - Phone:937-210-0685
Mailing Address - Fax:
Practice Address - Street 1:9588 CEMETERY RD
Practice Address - Street 2:
Practice Address - City:DE GRAFF
Practice Address - State:OH
Practice Address - Zip Code:43318-9547
Practice Address - Country:US
Practice Address - Phone:937-210-0685
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-29
Last Update Date:2023-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRP243606172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes172A00000XOther Service ProvidersDriverGroup - Multi-Specialty