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General NPI Number Information
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NPI Number | 1073107173
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Entity Type | Organization
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Legal Business Name | JORGE L. MERCADO RICHARDSON
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Dates
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Enumeration Date | 03/01/2021
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Last Update Date | 03/01/2021
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Provider Practice Location Address
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Address Line | 1315 E ROBINSON ST
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City | ORLANDO
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State | FL
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Zip | 32801-2117
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Country | US
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Telephone | 407-896-5656
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Fax | 407-897-6797
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Provider Business Mailing Address
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Address Line | 1315 E ROBINSON ST
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City | ORLANDO
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State | FL
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Zip | 32801-2117
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Country | US
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Telephone | 407-896-5656
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JORGE L. MERCADO
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Credential | DMD
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Telephone | 407-896-5656
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number |
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License Number State |
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