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1972516607
MICHAEL ROBERT MERRELL
REXBURG, ID
NPI
1972516607
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
Yes
Primary Taxonomy
122300000X Dentist
(Licence: ID D321)
Additional Taxonomies
122300000X Dentist
(Licence: ID D3211)
Enumeration Date
2006-08-14
Last Update Date
2024-01-10
Business Address
MICHAEL ROBERT MERRELL DDS
1183 SUMMERS DR
REXBURG, ID 83440-5224
Phone number: 208-356-9097
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Mailing Address
MICHAEL ROBERT MERRELL DDS
1183 SUMMERS DR
REXBURG, ID 83440-5224
Phone number: 208-356-9097
Copy
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