Healthcare Provider Details

I. General information

NPI: 1831232198
Provider Name (Legal Business Name): MERCERON BRUMAIRE R.D.H
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/15/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10300 SW 216TH ST
MIAMI FL
33190-1003
US

IV. Provider business mailing address

10300 SW 216TH ST
MIAMI FL
33190-1003
US

V. Phone/Fax

Practice location:
  • Phone: 305-242-2006
  • Fax:
Mailing address:
  • Phone: 305-242-2006
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License NumberDH11462
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: