| Doctor Name: | DR. JACOB DYLAN MERRYMAN |
| NPI Number: | 1104089903 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | DDS |
| License Number: | |
| Business Practice Address: | 453 Dixon Rd Suite #3 Queensbury, NY - 128041964 |
| Business Phone Number: | 5187933553 |
| Business Fax Number: | |
| Mailing Address: | 24 Pearl St, Apt #1 SCHUYLERVILLE |
| State: | NY |
| Postal Code: | 128711407 |
| Phone Number: | 5186954692 |
| Fax Number: | |
| NPI Enumeration Date: | 07/02/2008 |
| NPI Last Update Date: | 07/30/2009 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 390200000X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | |
| Taxonomy Type: | Student, Health Care |
| Taxonomy Classification: | Student in an Organized Health Care Education/Training Program |
| Taxonomy Specialization: | |
| Taxonomy Definition: | An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care. |