MEDICARE: NEW BOSTON DENTAL CLINIC PC

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	2901014931	MI

General Provider Information

NPI Number	:	1275636342
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEW BOSTON DENTAL CLINIC PC

Provider Business Mailing Address
First Line	:	37228 HURON RIVER DR
Second Line	:	PO BOX 217
City	:	NEW BOSTON
State	:	MI
Zip	:	48164-0217
Country	:	US
Telephone Number	:	734-753-4300
Fax Number	:	734-753-5139

Provider Business Practice Location Address
First Line	:	37228 HURON RIVER DR
Second Line	:
City	:	NEW BOSTON
State	:	MI
Zip	:	48164-0217
Country	:	US
Telephone Number	:	734-753-4300
Fax Number	:	734-753-5139

Authorized Official
Title or Position	:	OWNER PRESIDENT
Name	:	DR. DARIO MERLOS
Credential	:	DDS
Telephone Number	:	734-753-4300

Provider Enumeration Date	:	09/06/2006
Last Update Date	:	08/22/2020

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