=====================================================
General NPI Number Information
=====================================================
NPI Number | 1487058814
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MERIT DENTAL CARE, PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/14/2014
-----------------------------------------------------
Last Update Date | 10/14/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 12221 MERIT DR STE 470
-----------------------------------------------------
City | DALLAS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75251-2235
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 972-628-6440
-----------------------------------------------------
Fax | 972-628-6445
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 12221 MERIT DR STE 470
-----------------------------------------------------
City | DALLAS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75251-2235
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 972-628-6440
-----------------------------------------------------
Fax | 972-628-6445
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DENTIST
-----------------------------------------------------
Name | DR. JENNIFER DIANE HEDRICK
-----------------------------------------------------
Credential | D.D.S.
-----------------------------------------------------
Telephone | 972-628-6440
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | 25552
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------