Active NPI
Charles Max Merrill, DMD
- General Practice Dentistry
- Decatur, AL
National Provider Identifier
1013098235
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 2573
- Practice address
- 2424 Danville Road Suite O
Decatur, AL 35603 - Phone
- (256) 351-7707
- Fax
- (256) 351-7729
- NPI assigned
- Oct 17, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 2573 | AL | Primary |
Addresses
Primary practice location
2424 Danville Road Suite O
Decatur, AL 35603
Mailing address
P.O. Box 1287
Hartselle, AL 35640
Phone (256) 773-1407
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 836007 | Other | AL | UNITED CONCORDIA |
| 94685 | Other | AL | BLUE CROSS & BLUE SHIELD |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2573 | AL | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1161043200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1013098235",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "P.O. BOX 1287",
"city": "HARTSELLE",
"state": "AL",
"postal_code": "35640",
"telephone_number": "256-773-1407"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2424 DANVILLE ROAD SUITE O",
"city": "DECATUR",
"state": "AL",
"postal_code": "35603",
"telephone_number": "256-351-7707",
"fax_number": "256-351-7729"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MERRILL",
"first_name": "CHARLES",
"middle_name": "MAX",
"name_prefix": "Dr.",
"credential": "DMD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-10-17",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "AL",
"license": "2573",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UNITED CONCORDIA",
"identifier": "836007",
"state": "AL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS & BLUE SHIELD",
"identifier": "94685",
"state": "AL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Decatur, AL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.