MEDICARE: DR. ERIK RYDER MERTENS D.M.D

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	DS029805-L	PA

General Provider Information

NPI Number	:	1235221409
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ERIK RYDER MERTENS D.M.D

Provider Business Mailing Address
First Line	:	202 WINDERMERE CT
Second Line	:
City	:	MCMURRAY
State	:	PA
Zip	:	15317-3672
Country	:	US
Telephone Number	:	724-941-7746
Fax Number	:	724-941-8757

Provider Business Practice Location Address
First Line	:	3805 WASHINGTON RD
Second Line	:
City	:	MCMURRAY
State	:	PA
Zip	:	15317-2946
Country	:	US
Telephone Number	:	724-941-4990
Fax Number	:	724-941-8757

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

Provider Enumeration Date	:	09/28/2006
Last Update Date	:	07/08/2007

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