MEDICARE: DR. JAMES EDWARD MERTZEL 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	15092	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1740258482
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAMES EDWARD MERTZEL DDS

Provider Business Mailing Address
First Line	:	8120 FOOTHILL BLVD
Second Line	:
City	:	SUNLAND
State	:	CA
Zip	:	91040-2941
Country	:	US
Telephone Number	:	818-352-3174
Fax Number	:	818-352-0104

Provider Business Practice Location Address
First Line	:	8120 FOOTHILL BLVD
Second Line	:
City	:	SUNLAND
State	:	CA
Zip	:	91040-2941
Country	:	US
Telephone Number	:	818-352-3174
Fax Number	:	818-352-0104

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

Provider Enumeration Date	:	03/09/2006
Last Update Date	:	01/21/2016

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