Provider Demographics
NPI:1124590674
Name:M DENTAL 080,PLLC
Entity Type:Organization
Organization Name:M DENTAL 080,PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHIP
Authorized Official - Middle Name:
Authorized Official - Last Name:MERCER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:817-275-4817
Mailing Address - Street 1:725 N FIELDER RD
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76012-4636
Mailing Address - Country:US
Mailing Address - Phone:817-275-4817
Mailing Address - Fax:817-460-4881
Practice Address - Street 1:725 N FIELDER RD
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76012-4636
Practice Address - Country:US
Practice Address - Phone:817-275-4817
Practice Address - Fax:817-460-4881
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CHIP MERCER, DDS, PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-12-21
Last Update Date:2018-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty