MEDICARE: JORGE L. MERCADO RICHARDSON DMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	DN18781	FL

General Provider Information

NPI Number	:	1376715425
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JORGE L. MERCADO RICHARDSON DMD

Provider Business Mailing Address
First Line	:	1315 E ROBINSON ST
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32801-2117
Country	:	US
Telephone Number	:	407-896-5656
Fax Number	:	407-897-6797

Provider Business Practice Location Address
First Line	:	1315 E ROBINSON ST
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32801-2117
Country	:	US
Telephone Number	:	407-896-5656
Fax Number	:	407-897-6797

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/28/2008
Last Update Date	:	03/01/2021

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