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General NPI Number Information
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NPI Number | 1023476314
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Entity Type | Organization
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Legal Business Name | MERIT DENTAL INC
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Dates
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Enumeration Date | 02/02/2016
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Last Update Date | 02/02/2016
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Provider Practice Location Address
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Address Line | 155 E MARKET ST STE 3
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City | BLAIRSVILLE
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State | PA
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Zip | 15717-1357
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Country | US
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Telephone | 724-459-6240
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Fax | 724-459-0639
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Provider Business Mailing Address
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Address Line | 155 E MARKET ST STE 3
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City | BLAIRSVILLE
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State | PA
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Zip | 15717-1357
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Country | US
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Telephone | 724-459-6240
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Fax | 724-459-0639
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Authorized Official
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Title or Position | PC OWNER
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Name | JEFFREY MOOS
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Credential | DDS
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Telephone | 715-926-5050
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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