Healthcare Provider Details

I. General information

NPI: 1093729469
Provider Name (Legal Business Name): ALAN E MERCHANTHOUSE DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/28/2006
Last Update Date: 01/03/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

66 BLISS ST
REHOBOTH MA
02769-1902
US

IV. Provider business mailing address

66 BLISS ST
REHOBOTH MA
02769-1902
US

V. Phone/Fax

Practice location:
  • Phone: 508-252-4774
  • Fax:
Mailing address:
  • Phone: 508-252-4774
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number11919
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: