=====================================================
General NPI Number Information
=====================================================
NPI Number | 1093805574
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MERLYN L. CARVER, D.D.S., INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/13/2006
-----------------------------------------------------
Last Update Date | 06/13/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1408 LIVE OAK BLVD SUITE F
-----------------------------------------------------
City | YUBA CITY
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95991-2970
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 530-671-1810
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1408 LIVE OAK BLVD. SUITE F
-----------------------------------------------------
City | YUBA CITY
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95991
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 530-671-1810
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. MERLYN LEE CARVER
-----------------------------------------------------
Credential | D.D.S.
-----------------------------------------------------
Telephone | 530-671-1810
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QD0000X
-----------------------------------------------------
Taxonomy Name | Dental Clinic/Center
-----------------------------------------------------
License Number | 35851
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------