Provider Demographics
NPI:1982799631
Name:MEHARRY, MARLIN G (DDS,PC)
Entity Type:Individual
Prefix:DR
First Name:MARLIN
Middle Name:G
Last Name:MEHARRY
Suffix:
Gender:M
Credentials:DDS,PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:317 BREWSTER ST E
Mailing Address - Street 2:
Mailing Address - City:HARVEY
Mailing Address - State:ND
Mailing Address - Zip Code:58341-1653
Mailing Address - Country:US
Mailing Address - Phone:701-324-4693
Mailing Address - Fax:701-324-5289
Practice Address - Street 1:317 BREWSTER ST E
Practice Address - Street 2:
Practice Address - City:HARVEY
Practice Address - State:ND
Practice Address - Zip Code:58341-1653
Practice Address - Country:US
Practice Address - Phone:701-324-4693
Practice Address - Fax:701-324-5289
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND18681223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND949029OtherBLUE CROSS/ BLUE SHIELD
ND41198Medicaid