MEDICARE: DR. AMANDA ASHLEY 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	122300000X	Dentist	63478	CA

General Provider Information

NPI Number	:	1316351687
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. AMANDA ASHLEY MERCER DDS

Provider Business Mailing Address
First Line	:	5271 MELON CT
Second Line	:
City	:	RANCHO CUCAMONGA
State	:	CA
Zip	:	91739
Country	:	US
Telephone Number	:	909-908-7139
Fax Number	:

Provider Business Practice Location Address
First Line	:	36068 HIDDEN SPRINGS RD
Second Line	:
City	:	WILDOMAR
State	:	CA
Zip	:	92595-7679
Country	:	US
Telephone Number	:	951-678-0790
Fax Number	:

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

Provider Enumeration Date	:	06/16/2014
Last Update Date	:	06/16/2014

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