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General NPI Number Information
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NPI Number | 1235951252
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Entity Type | Organization
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Legal Business Name | MERCER FAMILY DENTAL LLC
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Dates
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Enumeration Date | 10/30/2024
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Last Update Date | 10/30/2024
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Provider Practice Location Address
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Address Line | 5222 US-51 N
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City | MERCER
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State | WI
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Zip | 54567
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Country | US
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Telephone | 715-476-3432
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Fax |
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Provider Business Mailing Address
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Address Line | 7701 BEAN RD
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City | WOODRUFF
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State | WI
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Zip | 54568-9620
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Country | US
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Telephone | 617-697-3613
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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. SAMANTHA JEFFERY
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Credential | DMD
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Telephone | 617-697-3613
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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 |
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License Number State |
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