Provider Demographics
NPI:1285381533
Name:MERKLEY MIDWEST - OHIO MARION I
Entity type:Organization
Organization Name:MERKLEY MIDWEST - OHIO MARION I
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:MERKLEY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:801-592-5541
Mailing Address - Street 1:1271 CRESCENT HEIGHTS RD STE 206
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:OH
Mailing Address - Zip Code:43302-6455
Mailing Address - Country:US
Mailing Address - Phone:740-383-2525
Mailing Address - Fax:
Practice Address - Street 1:1271 CRESCENT HEIGHTS RD STE 206
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:OH
Practice Address - Zip Code:43302-6455
Practice Address - Country:US
Practice Address - Phone:740-383-2525
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-07
Last Update Date:2022-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty