=====================================================
General NPI Number Information
=====================================================
NPI Number | 1588764419
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MERCER CHILDREN'S DENTISTRY, PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/22/2006
-----------------------------------------------------
Last Update Date | 06/10/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3131 PRINCETON PIKE BUILDING 6, SUITE 108
-----------------------------------------------------
City | LAWRENCEVILLE
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08648-2201
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 609-896-2006
-----------------------------------------------------
Fax | 609-869-3889
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3131 PRINCETON PIKE BUILDING 6, SUITE 108
-----------------------------------------------------
City | LAWRENCEVILLE
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08648-2201
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 609-896-2006
-----------------------------------------------------
Fax | 609-869-3889
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. BRIAN KEITH ALLEN
-----------------------------------------------------
Credential | DMD
-----------------------------------------------------
Telephone | 609-896-2006
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223P0221X
-----------------------------------------------------
Taxonomy Name | Pediatric Dentistry
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------