Provider Demographics
NPI:1205719127
Name:MERROW, KRISTA KAY (RDH)
Entity type:Individual
Prefix:MRS
First Name:KRISTA
Middle Name:KAY
Last Name:MERROW
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4944 WAGON TRAIL CT SE
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97317-7101
Mailing Address - Country:US
Mailing Address - Phone:503-851-9188
Mailing Address - Fax:
Practice Address - Street 1:2510 12TH ST SE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97302-2167
Practice Address - Country:US
Practice Address - Phone:503-378-1212
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-29
Last Update Date:2025-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORH7615124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist