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General NPI Number Information
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NPI Number | 1164455234
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Entity Type | Individual
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Provider Name | DAVID L MERELLO DDS, PC
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Gender | Male
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Dates
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Enumeration Date | 07/09/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 12508 WINCHESTER AVE
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City | GRANDVIEW
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State | MO
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Zip | 64030-2059
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Country | US
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Telephone | 816-761-9343
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Fax |
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Provider Business Mailing Address
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Address Line | 2135 N STATE RT 7
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City | PLEASANT HILL
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State | MO
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Zip | 64080
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Country | US
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Telephone | 816-540-2143
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | MO 12663
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License Number State | MO
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