Provider Demographics
NPI:1104389097
Name:MERCER DENTAL LLC
Entity Type:Organization
Organization Name:MERCER DENTAL LLC
Other - Org Name:RASMUSSEN DENTAL LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DEREK
Authorized Official - Middle Name:
Authorized Official - Last Name:RASMUSSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:715-439-5365
Mailing Address - Street 1:8796 BRUNSWICK RD
Mailing Address - Street 2:
Mailing Address - City:MINOCQUA
Mailing Address - State:WI
Mailing Address - Zip Code:54548-9346
Mailing Address - Country:US
Mailing Address - Phone:715-439-5365
Mailing Address - Fax:
Practice Address - Street 1:5222 HWY 51 N
Practice Address - Street 2:
Practice Address - City:MERCER
Practice Address - State:WI
Practice Address - Zip Code:54547
Practice Address - Country:US
Practice Address - Phone:715-476-3432
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-09
Last Update Date:2019-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental