Provider Demographics
NPI:1104934959
Name:MERRITT, MARK J (DDS)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:J
Last Name:MERRITT
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1009 CHEEK SPARGER RD
Mailing Address - Street 2:STE 102
Mailing Address - City:COLLEYVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:76034
Mailing Address - Country:US
Mailing Address - Phone:817-581-7904
Mailing Address - Fax:817-581-0037
Practice Address - Street 1:1009 CHEEK SPARGER RD
Practice Address - Street 2:STE 102
Practice Address - City:COLLEYVILLE
Practice Address - State:TX
Practice Address - Zip Code:76034
Practice Address - Country:US
Practice Address - Phone:817-581-7904
Practice Address - Fax:817-581-0037
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX14787122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist