Provider Demographics
NPI:1184700742
Name:EATON, MERLIN DALE (DDS)
Entity type:Individual
Prefix:DR
First Name:MERLIN
Middle Name:DALE
Last Name:EATON
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1631 COMMERCIAL ST
Mailing Address - Street 2:
Mailing Address - City:WARSAW
Mailing Address - State:MO
Mailing Address - Zip Code:65355-3060
Mailing Address - Country:US
Mailing Address - Phone:660-438-5139
Mailing Address - Fax:660-438-8649
Practice Address - Street 1:1631 COMMERCIAL ST
Practice Address - Street 2:
Practice Address - City:WARSAW
Practice Address - State:MO
Practice Address - Zip Code:65355-3060
Practice Address - Country:US
Practice Address - Phone:660-438-5139
Practice Address - Fax:660-438-8649
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO012695122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist