Healthcare Provider Details

I. General information

NPI: 1528801214
Provider Name (Legal Business Name): GABRIELLE M MERCIECA DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2024
Last Update Date: 07/20/2025
Certification Date: 07/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22181 PONTIAC TRL
SOUTH LYON MI
48178-1638
US

IV. Provider business mailing address

48296 RED RUN DR
CANTON MI
48187-5433
US

V. Phone/Fax

Practice location:
  • Phone: 734-936-5950
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number2901602137
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: