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General NPI Number Information
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NPI Number | 1619150802
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Entity Type | Individual
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Provider Name | BRUCE ARTHUR MERRIAM DDS
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Gender | Male
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Dates
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Enumeration Date | 12/11/2007
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Last Update Date | 12/11/2007
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Provider Practice Location Address
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Address Line | 250 PATCHOGUE YAPHANK RD SUITE 9
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City | EAST PATCHOGUE
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State | NY
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Zip | 11772-4800
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Country | US
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Telephone | 631-475-3400
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Fax | 631-475-3465
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Provider Business Mailing Address
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Address Line | 250 PATCHOGUE YAPHANK RD SUITE 9
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City | EAST PATCHOGUE
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State | NY
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Zip | 11772-4800
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Country | US
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Telephone | 631-475-3400
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Fax | 631-475-3465
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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 | 1223E0200X
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Taxonomy Name | Endodontics
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License Number | 028780-1
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License Number State | NY
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