Healthcare Provider Details

I. General information

NPI: 1841500972
Provider Name (Legal Business Name): ROBERT S. MERRITT DMD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/07/2010
Last Update Date: 10/07/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4610 OLEANDER DR SUITE 103
MYRTLE BEACH SC
29577-5752
US

IV. Provider business mailing address

4610 OLEANDER DR SUITE 103
MYRTLE BEACH SC
29577-5752
US

V. Phone/Fax

Practice location:
  • Phone: 843-449-7114
  • Fax: 843-449-2554
Mailing address:
  • Phone: 843-449-7114
  • Fax: 843-449-2554

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number4131
License Number StateSC

VIII. Authorized Official

Name: ROBERT SPANN MERRITT
Title or Position: PRESIDENT
Credential:
Phone: 843-449-7114