Provider Demographics
NPI:1548304496
Name:HUGENTOBLER, MERRILL M (DDS)
Entity type:Individual
Prefix:
First Name:MERRILL
Middle Name:M
Last Name:HUGENTOBLER
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 1:757 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MOAB
Mailing Address - State:UT
Mailing Address - Zip Code:84532-2132
Mailing Address - Country:US
Mailing Address - Phone:435-259-7418
Mailing Address - Fax:435-259-4036
Practice Address - Street 1:757 N MAIN ST
Practice Address - Street 2:
Practice Address - City:MOAB
Practice Address - State:UT
Practice Address - Zip Code:84532-2132
Practice Address - Country:US
Practice Address - Phone:435-259-7418
Practice Address - Fax:435-259-4036
Is Sole Proprietor?:No
Enumeration Date:2007-02-16
Last Update Date:2011-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT2751411223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice