Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223X0400X | Orthodontists | DE00006296 | WA |
NPI | 1003136599 |
---|---|
Provider Name | Robert Monte Merrill |
First Address | East Wenatchee, WA 98802-7665 |
Second Address | East Wenatchee, WA 98802-7665 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/06/2010 |
Last Update Date | 07/06/2010 |