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General NPI Number Information
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NPI Number | 1659894780
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Entity Type | Organization
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Legal Business Name | MERIT DENTAL II - MICHIGAN, PC
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Dates
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Enumeration Date | 07/20/2017
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Last Update Date | 07/20/2017
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Provider Practice Location Address
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Address Line | 4189 HIGHLAND RD
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City | WATERFORD
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State | MI
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Zip | 48328-2136
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Country | US
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Telephone | 248-682-9653
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Fax | 248-682-9266
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Provider Business Mailing Address
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Address Line | 680 HEHLI WAY
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City | MONDOVI
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State | WI
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Zip | 54755-1639
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Country | US
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Telephone | 715-598-2311
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Fax | 715-350-6855
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Authorized Official
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Title or Position | DIRECTOR, PAYER STRATEGY
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Name | CHAD HENDRICKS
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Credential |
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Telephone | 612-351-6876
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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