Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | IL |
NPI | 1003921362 |
---|---|
Provider Name | Carolyn H Merrill |
First Address | Llibertyville, IL 60048-1314 |
Second Address | Llibertyville, IL 60048-1314 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/08/2006 |
Last Update Date | 08/07/2007 |