Basic Information
| Provider Information | |||||||||
| NPI: | 1396716676 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MERRIFIELD | ||||||||
| FirstName: | RICHARD | ||||||||
| MiddleName: | P | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | IV | ||||||||
| Credential: | DDS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 34800 BOB WILSON DR | ||||||||
| Address2: | NMCSD, ATTN: MEDICAL STAFF SERVICES | ||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921341098 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6195326460 | ||||||||
| FaxNumber: | 6195326299 | ||||||||
| Practice Location | |||||||||
| Address1: | 34800 BOB WILSON DR | ||||||||
| Address2: | NMCSD, ATTN: MEDICAL STAFF SERVICES | ||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921341098 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6195326460 | ||||||||
| FaxNumber: | 6195326299 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/27/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1223S0112X | DDS 52240 | CA | Y | Dental Providers | Dentist | Oral and Maxillofacial Surgery |
No ID Information.