Doctor Name: | MR. JOHN FREEMAN MERRILL |
NPI Number: | 1548587819 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | L.D |
License Number: | 5012 |
Business Practice Address: | 1075 Stage Rd Etna, ME - 04434 |
Business Phone Number: | 2072694570 |
Business Fax Number: | |
Mailing Address: | Po Box 107, ETNA |
State: | ME |
Postal Code: | 044340107 |
Phone Number: | 2072694570 |
Fax Number: | |
NPI Enumeration Date: | 04/27/2010 |
NPI Last Update Date: | 04/27/2010 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 122400000X |
License Number: | 5012 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | ME |
Taxonomy Type: | Dental Providers |
Taxonomy Classification: | Denturist |
Taxonomy Specialization: | |
Taxonomy Definition: |