Provider Demographics
NPI:1477691913
Name:DR. NELSON A. MERCADO CASTRO, CSP
Entity Type:Organization
Organization Name:DR. NELSON A. MERCADO CASTRO, CSP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NELSON
Authorized Official - Middle Name:A
Authorized Official - Last Name:MERCADO
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:787-882-0368
Mailing Address - Street 1:PO BOX 684
Mailing Address - Street 2:
Mailing Address - City:AGUADA
Mailing Address - State:PR
Mailing Address - Zip Code:00602-0684
Mailing Address - Country:US
Mailing Address - Phone:787-882-0368
Mailing Address - Fax:787-997-1735
Practice Address - Street 1:8 AVE LOS ROBLES
Practice Address - Street 2:CUESTA VIEJA
Practice Address - City:AGUADILLA
Practice Address - State:PR
Practice Address - Zip Code:00603-5643
Practice Address - Country:US
Practice Address - Phone:787-882-0368
Practice Address - Fax:787-997-1735
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PRD23731223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty