Individual
MICHAEL ROBERT MERRELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
1183 SUMMERS DR, REXBURG, ID 83440-5224
(208) 356-9097
Mailing address
1183 SUMMERS DR, REXBURG, ID 83440-5224
(208) 356-9097
(208) 359-2021
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
D321
ID
122300000X
Dentist
D3211
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000980900
—
ID
Enumeration date
08/14/2006
Last updated
01/10/2024
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