Provider Demographics
NPI:1487987087
Name:MERRELL C. STILL JR. DMD PA
Entity type:Organization
Organization Name:MERRELL C. STILL JR. DMD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:S
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:803-259-1124
Mailing Address - Street 1:10982 ELLENTON ST
Mailing Address - Street 2:
Mailing Address - City:BARNWELL
Mailing Address - State:SC
Mailing Address - Zip Code:29812-7304
Mailing Address - Country:US
Mailing Address - Phone:803-259-1124
Mailing Address - Fax:803-259-9801
Practice Address - Street 1:10982 ELLENTON ST
Practice Address - Street 2:
Practice Address - City:BARNWELL
Practice Address - State:SC
Practice Address - Zip Code:29812-7304
Practice Address - Country:US
Practice Address - Phone:803-259-1124
Practice Address - Fax:803-259-9801
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-14
Last Update Date:2009-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4609122300000X
SC3022122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCZ30229Medicaid