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General NPI Number Information
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NPI Number | 1184133621
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Entity Type | Organization
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Legal Business Name | MERCER FAMILY DENTISTRY, INC.
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Dates
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Enumeration Date | 09/27/2017
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Last Update Date | 09/27/2017
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Provider Practice Location Address
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Address Line | 1105 W STONE DR STE 1
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City | KINGSPORT
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State | TN
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Zip | 37660-2558
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Country | US
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Telephone | 423-246-7900
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Fax |
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Provider Business Mailing Address
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Address Line | 1105 W STONE DR STE 1
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City | KINGSPORT
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State | TN
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Zip | 37660-2558
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. JEFFREY BRIAN MERCER
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Credential | DDS
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Telephone | 423-723-5130
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 8604
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License Number State | TN
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