Individual
DR. JACOB DYLAN MERRYMAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
453 DIXON RD, SUITE #3, QUEENSBURY, NY 12804-1964
(518) 793-3553
Mailing address
24 PEARL ST, APT #1, SCHUYLERVILLE, NY 12871-1407
(518) 695-4692
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
50 054420
NY
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
07/02/2008
Last updated
07/30/2009
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