Provider Demographics
NPI:1285913343
Name:MERRELL, DAVID WEBBER (DDS)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:WEBBER
Last Name:MERRELL
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 1:930A W SHAWNEE ST
Mailing Address - Street 2:
Mailing Address - City:MUSKOGEE
Mailing Address - State:OK
Mailing Address - Zip Code:74401-3511
Mailing Address - Country:US
Mailing Address - Phone:918-723-9931
Mailing Address - Fax:918-723-9932
Practice Address - Street 1:930A W SHAWNEE ST
Practice Address - Street 2:
Practice Address - City:MUSKOGEE
Practice Address - State:OK
Practice Address - Zip Code:74401-3511
Practice Address - Country:US
Practice Address - Phone:918-723-9931
Practice Address - Fax:918-723-9932
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-08
Last Update Date:2024-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1211223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA9178644Medicaid