Healthcare Provider Details

I. General information

NPI: 1093173395
Provider Name (Legal Business Name): MERIT DENTAL INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/02/2016
Last Update Date: 02/02/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21 BALDWIN BLVD
SHAMOKIN DAM PA
17876-9514
US

IV. Provider business mailing address

21 BALDWIN BLVD
SHAMOKIN DAM PA
17876-9514
US

V. Phone/Fax

Practice location:
  • Phone: 570-743-3300
  • Fax: 570-743-7555
Mailing address:
  • Phone: 570-743-3300
  • Fax: 570-743-7555

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: JEFFREY MOOS
Title or Position: PC OWNER
Credential: DDS
Phone: 715-926-5050