DR. JACOB DYLAN MERRYMAN (NPI# 1104089903) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1104089903 |
| Entity Type | Individual |
| Full Name | DR. JACOB DYLAN MERRYMAN |
| Credential | DDS |
| Practice Address |
453 Dixon Rd Suite #3 Queensbury NY 12804-1964 |
| Mailing Address |
24 Pearl St Apt #1 Schuylerville NY 12871-1407 |
| Practice Telephone | 5187933553 |
| Mailing Telephone | 5186954692 |
| Enumeration Date | 2008-07-02 |
| Last Update Date | 2009-07-30 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 122300000X | Dentist | 50 054420 | NY | Dental Providers |
| N | 390200000X | Student in an Organized Health Care Education/Training Program | Student, Health Care |
| Street Address |
453 DIXON RD SUITE #3 |
| City | QUEENSBURY |
| State | NY |
| Zip Code | 12804-1964 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1801899745 | H John Schutze II | Dentist | 453 Dixon Rd, Ste 3, Queensbury, NY 12804-1964 | 2005-05-24 |
| 1467865618 | Mark A Franklin | Dentist | 453 Dixon Rd, Suite 5, Queensbury, NY 12804-1949 | 2014-06-05 |
| 1295027217 | Traci Lee Phillips-perkins | Social Worker | 453 Dixon Rd, Bldg. 3 Ste. 8, Queensbury, NY 12804-1949 | 2011-05-10 |
| 1932409810 | Elizabeth Karen Samenfeld-specht | Marriage & Family Therapist | 453 Dixon Rd, Bldg 3, Suite 6, Queensbury, NY 12804-1964 | 2010-10-26 |
| 1972711620 | Ronald Joseph Delsignore | Dentist | 453 Dixon Rd, Suite 4, Queensbury, NY 12804-1964 | 2007-05-18 |
| 1598985137 | Patrick J. Esmond Dds, Pllc | Dentist | 453 Dixon Rd, Suite 5, Queensbury, NY 12804-1964 | 2007-04-26 |
| 1073640231 | William Daniel Billington | Dentist | 453 Dixon Rd, Queensbury, NY 12804-1964 | 2007-02-27 |
| 1881602860 | Patrick J Esmond | Dentist | 453 Dixon Rd, Suite 5, Queensbury, NY 12804 | 2006-08-04 |
| 1225058753 | Lilianne N Dobert | Social Worker | 453 Dixon Rd, Bldg 3 Ste 8, Queensbury, NY 12804-1949 | 2006-07-20 |
| 1871553719 | Jonathan Michael Schutze | Dentist | 453 Dixon Rd, Suite 3, Queensbury, NY 12804-1964 | 2006-03-24 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1265060958 | Dani Grace Filicetti | Student in an Organized Health Care Education/Training Program | 423 Bay Rd, Queensbury, NY 12804 | 2020-03-30 |
| 1861977704 | Leslie Ann Warren | Counselor | 24 Cedarwood Drive, Queensbury, NY 12804 | 2018-09-26 |
| 1598294910 | Molly Gillespie | Speech-Language Pathologist | 9 Sylvan Ave, Queensbury, NY 12804 | 2017-06-08 |
| 1306207196 | Dorothy Duggan | Registered Nurse | 128 Aviation Road, Queensbury, NY 12804 | 2016-03-08 |
| 1568731115 | Kph Healthcare Services, Inc. | Pharmacy | 161 Carey Road, Queensbury, NY 12804 | 2011-12-27 |
| 1164701017 | Wal-mart Stores East Lp | Technician/Technologist | 24 Quaker Ridge Blvd, Queensbury, NY 12804 | 2011-08-10 |
| 1821275256 | Koock E Jung Md PC | Social Worker | 597 Bay Road, Queensbury, NY 12804 | 2008-01-29 |
| 1477765246 | Warren Washington Counties Chapter Nysarc Inc. | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 375 Bay Road, Suite 200, Queensbury, NY 12804 | 2007-05-04 |
| 1336299742 | Town of Queensbury Union Free School District 2 | Local Education Agency (LEA) | 429 Aviation Road, Queensbury, NY 12804 | 2007-01-11 |
| 1578658761 | Richard Jay Reisman | Dentist | 8 Baywood Drive, Glens Falls, NY 12804 | 2006-10-04 |
| Find all providers in zip 12804 | ||||
| Taxonomy Code | 122300000X |
| Grouping | Dental Providers |
| Classification | Dentist |
| A dentist is a person qualified by a doctorate in dental surgery (D.D.S.) or dental medicine (D.M.D.), licensed by the state to practice dentistry, and practicing within the scope of that license. There is no difference between the two degrees: dentists who have a DMD or DDS have the same education. Universities have the prerogative to determine what degree is awarded. Both degrees use the same curriculum requirements set by the American Dental Association's Commission on Dental Accreditation. Generally, three or more years of undergraduate education plus four years of dental school is required to graduate and become a general dentist. State licensing boards accept either degree as equivalent, and both degrees allow licensed individuals to practice the same scope of general dentistry. Additional post-graduate training is required to become a dental specialist. |
| Notes: Source: Council on Dental Education and Licensure, American Dental Association |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1689020679 | Baybrook Dental Group | Dentist | 31 Willowbrook Rd, Queensbury, NY 12804-5864 | 2016-05-09 |
| 1346529484 | Family Dentistry of Dr Jessica Shin, Pllc | Dentist | 365 Aviation Rd, Queensbury, NY 12804-2915 | 2011-08-08 |
| 1821012881 | Timothy S Kelling | Dentist | 4 Fairfield Dr, Queensbury, NY 12804-1514 | 2006-07-26 |
| 1891357067 | Cottrell and Mccullough Dental Pllc | Dentist | 36 Homer Ave, Queensbury, NY 12804-2009 | 2019-07-08 |
| 1376906156 | Family Dentistry of Dr Jessica Shin, Pllc | Dentist | 365 Aviation Rd, Queensbury, NY 12804-2915 | 2016-03-30 |
| 1154737526 | Carly Mccullough | Dentist | 36 Homer Ave, Queensbury, NY 12804-2009 | 2014-07-07 |
| 1467865618 | Mark A Franklin | Dentist | 453 Dixon Rd, Suite 5, Queensbury, NY 12804-1949 | 2014-06-05 |
| 1114359387 | Capital Area Hudson Valley Ny Dental PC | Dentist | 123 Quaker Rd, Suite 101, Queensbury, NY 12804-1714 | 2013-07-30 |
| 1154663060 | Laura J Cloke | Dentist | 36 Homer Ave, Queensbury, NY 12804-2009 | 2013-03-19 |
| 1033492244 | Claire Anna Kiehl | Dentist | 1st Advantage Dental, 1092 Route 9, Queensbury, NY 12804-0382 | 2011-09-23 |
| Find all providers in QUEENSBURY | ||||
| City | QUEENSBURY |
| Zip Code | 12804 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.