Healthcare Provider Details

I. General information

NPI: 1164723763
Provider Name (Legal Business Name): JOSHUA D. MERRILL, DDS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/12/2010
Last Update Date: 11/12/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

63 E MAIN ST
NEW LONDON OH
44851-1233
US

IV. Provider business mailing address

63 E MAIN ST
NEW LONDON OH
44851-1233
US

V. Phone/Fax

Practice location:
  • Phone: 419-929-1544
  • Fax: 419-929-0402
Mailing address:
  • Phone: 419-929-1544
  • Fax: 419-929-0402

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number30022573
License Number StateOH

VIII. Authorized Official

Name: DR. JOSHUA D MERRILL
Title or Position: OWNER
Credential: DDS
Phone: 419-929-1544