Healthcare Provider Details

I. General information

NPI: 1851392658
Provider Name (Legal Business Name): MERLIN DAVID EKVALL D.D.S., M.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 08/03/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 JASMINE ST SUITE 4
OMAK WA
98841-9501
US

IV. Provider business mailing address

800 S. JASMINE STREET SUITE 4
OMAK WA
98841
US

V. Phone/Fax

Practice location:
  • Phone: 509-826-4831
  • Fax: 509-826-6741
Mailing address:
  • Phone: 509-826-4831
  • Fax: 509-826-6741

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number7125
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: