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General NPI Number Information
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NPI Number | 1114120151
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Entity Type | Individual
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Provider Name | JEFFREY BRIAN MERCER D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 06/07/2007
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Last Update Date | 08/15/2011
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Provider Practice Location Address
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Address Line | 613 WATAUGA ST
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City | KINGSPORT
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State | TN
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Zip | 37660-4429
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Country | US
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Telephone | 423-247-7741
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Fax | 423-247-7441
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Provider Business Mailing Address
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Address Line | 518 SELKIRK DR
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City | KINGSPORT
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State | TN
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Zip | 37664-4461
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Country | US
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Telephone | 423-723-5130
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DS8604
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License Number State | TN
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DS8604
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License Number State | TN
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