Healthcare Provider Details

I. General information

NPI: 1235951252
Provider Name (Legal Business Name): MERCER FAMILY DENTAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/30/2024
Last Update Date: 10/30/2024
Certification Date: 10/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5222 US-51 N
MERCER WI
54567
US

IV. Provider business mailing address

7701 BEAN RD
WOODRUFF WI
54568-9620
US

V. Phone/Fax

Practice location:
  • Phone: 715-476-3432
  • Fax:
Mailing address:
  • Phone: 617-697-3613
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. SAMANTHA JEFFERY
Title or Position: OWNER
Credential: DMD
Phone: 617-697-3613