Provider Demographics
NPI:1003908203
Name:MERTENS, JEFFREY WILSHIRE (DMD)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:WILSHIRE
Last Name:MERTENS
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:91 ALEXANDER DR
Mailing Address - Street 2:
Mailing Address - City:MCMURRAY
Mailing Address - State:PA
Mailing Address - Zip Code:15317-2689
Mailing Address - Country:US
Mailing Address - Phone:724-941-6484
Mailing Address - Fax:724-941-8757
Practice Address - Street 1:3805 WASHINGTON RD
Practice Address - Street 2:
Practice Address - City:MCMURRAY
Practice Address - State:PA
Practice Address - Zip Code:15317-2946
Practice Address - Country:US
Practice Address - Phone:724-941-4990
Practice Address - Fax:724-941-8757
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS017211L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice