Provider Demographics
NPI:1144627555
Name:DAVID W MERRELL DDS MSD PLC
Entity type:Organization
Organization Name:DAVID W MERRELL DDS MSD PLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PEDIATRIC DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:W
Authorized Official - Last Name:MERRELL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MSD
Authorized Official - Phone:804-741-1400
Mailing Address - Street 1:12205 GAYTON ROAD
Mailing Address - Street 2:SUITE A
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23238-3212
Mailing Address - Country:US
Mailing Address - Phone:804-741-1400
Mailing Address - Fax:804-741-7700
Practice Address - Street 1:12205 GAYTON ROAD
Practice Address - Street 2:SUITE A
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23238-3212
Practice Address - Country:US
Practice Address - Phone:804-741-1400
Practice Address - Fax:804-741-7700
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-01
Last Update Date:2014-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014139331223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA9178644Medicaid