Healthcare Provider Details

I. General information

NPI: 1295892115
Provider Name (Legal Business Name): JEFFREY V. MERRIFIELD, D.D.S., INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/02/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2664 BERRYESSA RD STE 116
SAN JOSE CA
95132-2906
US

IV. Provider business mailing address

2664 BERRYESSA RD STE 116
SAN JOSE CA
95132-2906
US

V. Phone/Fax

Practice location:
  • Phone: 408-849-5333
  • Fax: 408-929-5780
Mailing address:
  • Phone: 408-849-5333
  • Fax: 408-929-5780

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number18736
License Number StateCA

VIII. Authorized Official

Name: DR. JEFF MERRIFIELD
Title or Position: PRESTREAS
Credential: D.D.S.
Phone: 408-849-5333