1659894780 NPI number — MERIT DENTAL II - MICHIGAN, PC

Table of content: NANCY LYNN CATAYAS MSW, LCSW (NPI 1407903305)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1659894780 NPI number — MERIT DENTAL II - MICHIGAN, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MERIT DENTAL II - MICHIGAN, PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1659894780
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/20/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
680 HEHLI WAY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MONDOVI
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
54755-1639
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
715-598-2311
Provider Business Mailing Address Fax Number:
715-350-6855

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4189 HIGHLAND RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WATERFORD
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48328-2136
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
248-682-9653
Provider Business Practice Location Address Fax Number:
248-682-9266
Provider Enumeration Date:
07/20/2017

Additional Information

Authorized Official

Authorized Official Last Name:
HENDRICKS
Authorized Official First Name:
CHAD
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR, PAYER STRATEGY
Authorized Official Telephone Number:
612-351-6876

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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