Provider Demographics
NPI:1962514240
Name:MERCKEL, KENNETH EDGAR (DDS)
Entity type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:EDGAR
Last Name:MERCKEL
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 294
Mailing Address - Street 2:6093 FULTON ST
Mailing Address - City:MAYVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48744
Mailing Address - Country:US
Mailing Address - Phone:989-843-6431
Mailing Address - Fax:989-843-6511
Practice Address - Street 1:6093 FULTON ST
Practice Address - Street 2:
Practice Address - City:MAYVILLE
Practice Address - State:MI
Practice Address - Zip Code:48744
Practice Address - Country:US
Practice Address - Phone:989-843-6431
Practice Address - Fax:989-843-6431
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010087821223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics