Healthcare Provider Details

I. General information

NPI: 1942250337
Provider Name (Legal Business Name): MILTON P MERRITT DDS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/10/2006
Last Update Date: 04/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23-35 BELL BOULEVARD
BAYSIDE NY
11360-2038
US

IV. Provider business mailing address

23-35 BELL BOULEVARD
BAYSIDE NY
11360-2038
US

V. Phone/Fax

Practice location:
  • Phone: 718-225-5454
  • Fax: 718-225-5455
Mailing address:
  • Phone: 718-225-5454
  • Fax: 718-225-5455

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number21975
License Number StateNY

VIII. Authorized Official

Name: DR. MILTON PHILIP MERRITT
Title or Position: PRESIDENT
Credential: DDS
Phone: 718-225-5454