MEDICARE: DR. ROBERT SHERMAN MERRILL DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	2537-015	WI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1073511416
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROBERT SHERMAN MERRILL DDS

Provider Business Mailing Address
First Line	:	112 S STONE ST
Second Line	:	P.O. BOX 25
City	:	AUGUSTA
State	:	WI
Zip	:	54722-7221
Country	:	US
Telephone Number	:	715-286-2960
Fax Number	:

Provider Business Practice Location Address
First Line	:	112 S STONE ST
Second Line	:
City	:	AUGUSTA
State	:	WI
Zip	:	54722-7221
Country	:	US
Telephone Number	:	715-286-2960
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/11/2005
Last Update Date	:	07/09/2007

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