Jacob Dylan Merryman, DDS

Primary specialty

DentistTaxonomy code 122300000X

License

50 054420 Issued in NY

Practice address

453 Dixon Rd
Suite #3
Queensbury, NY 12804-1964

Phone

(518) 793-3553

NPI assigned

Jul 2, 2008

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1214956800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1248912000000",
    "number": "1104089903",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "24 PEARL ST",
            "address_2": "APT #1",
            "city": "SCHUYLERVILLE",
            "state": "NY",
            "postal_code": "128711407",
            "telephone_number": "518-695-4692"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "453 DIXON RD",
            "address_2": "SUITE #3",
            "city": "QUEENSBURY",
            "state": "NY",
            "postal_code": "128041964",
            "telephone_number": "518-793-3553"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MERRYMAN",
        "first_name": "JACOB",
        "middle_name": "DYLAN",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2008-07-02",
        "last_updated": "2009-07-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "NY",
            "license": "50 054420",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Charles H Menzel, MD
• Christina Ann Mercier, PMHNP-BC
• James P Merrigan, PHD
• Jeffrey Merrigan
• Donald R Merrihew Jr., M.D.
• Hannah Messenger, LMSW
• Gregory David Meyers, PHARMD
• Patricia Middleton
• Scott C Miller, PA-C
• Lori Millis, PH.D.

• All providers in Queensbury, NY
• Dentist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 30, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.