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General NPI Number Information
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NPI Number | 1144627555
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Entity Type | Organization
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Legal Business Name | DAVID W MERRELL DDS MSD PLC
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Dates
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Enumeration Date | 12/01/2014
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Last Update Date | 12/01/2014
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Provider Practice Location Address
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Address Line | 12205 GAYTON ROAD SUITE A
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City | RICHMOND
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State | VA
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Zip | 23238-3212
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Country | US
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Telephone | 804-741-1400
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Fax | 804-741-7700
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Provider Business Mailing Address
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Address Line | 12205 GAYTON ROAD SUITE A
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City | RICHMOND
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State | VA
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Zip | 23238-3212
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Country | US
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Telephone | 804-741-1400
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Fax | 804-741-7700
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Authorized Official
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Title or Position | PEDIATRIC DENTIST
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Name | DR. DAVID W MERRELL
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Credential | DDS, MSD
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Telephone | 804-741-1400
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 0401413933
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License Number State | VA
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