MEDICARE: MITCHELL 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	DEN.00205674	CO

General Provider Information

NPI Number	:	1366124935
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MITCHELL MERRILL DDS

Provider Business Mailing Address
First Line	:	1667 COCHRANE CIR BLDG 7495
Second Line	:
City	:	FORT CARSON
State	:	CO
Zip	:	80913-4603
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6990 QUINN ST BLDG 2356
Second Line	:
City	:	FORT CARSON
State	:	CO
Zip	:	80913-4450
Country	:	US
Telephone Number	:	719-526-2200
Fax Number	:

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

Provider Enumeration Date	:	08/03/2023
Last Update Date	:	05/18/2026

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