Healthcare Provider Details

I. General information

NPI: 1992844138
Provider Name (Legal Business Name): BARRY N. MERCER D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/05/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3475 TAYLOR RD.
LOOMIS CA
95650-0005
US

IV. Provider business mailing address

PO BOX 5
LOOMIS CA
95650-0005
US

V. Phone/Fax

Practice location:
  • Phone: 916-652-5424
  • Fax: 916-652-8945
Mailing address:
  • Phone: 916-652-5424
  • Fax: 916-652-8945

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number39842
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: