MEDICARE: DR. MARK W MERCER DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	012202	MI

General Provider Information

NPI Number	:	1184603771
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARK W MERCER DDS

Provider Business Mailing Address
First Line	:	W492 PORTAGE ST
Second Line	:
City	:	SAINT IGNACE
State	:	MI
Zip	:	49781-0099
Country	:	US
Telephone Number	:	906-643-8414
Fax Number	:	906-643-9144

Provider Business Practice Location Address
First Line	:	W492 PORTAGE ST
Second Line	:
City	:	SAINT IGNACE
State	:	MI
Zip	:	49781-0099
Country	:	US
Telephone Number	:	906-643-8414
Fax Number	:	906-643-9144

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/11/2006
Last Update Date	:	09/25/2007

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