Provider Demographics
NPI:1144758145
Name:MERRELL, JOSHUA LOGAN (DDS)
Entity type:Individual
Prefix:DR
First Name:JOSHUA
Middle Name:LOGAN
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 1:5024 LACEY BLVD SE
Mailing Address - Street 2:
Mailing Address - City:LACEY
Mailing Address - State:WA
Mailing Address - Zip Code:98503-5729
Mailing Address - Country:US
Mailing Address - Phone:201-919-1426
Mailing Address - Fax:
Practice Address - Street 1:5024 LACEY BLVD SE
Practice Address - Street 2:
Practice Address - City:LACEY
Practice Address - State:WA
Practice Address - Zip Code:98503-5729
Practice Address - Country:US
Practice Address - Phone:201-919-1426
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-02
Last Update Date:2024-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE608810581223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice