Provider Demographics
NPI:1568935252
Name:MERCADO, VICTOR ALFONSO (DDS)
Entity Type:Individual
Prefix:
First Name:VICTOR
Middle Name:ALFONSO
Last Name:MERCADO
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:285 DRIFTWOOD DR
Mailing Address - Street 2:
Mailing Address - City:BAY POINT
Mailing Address - State:CA
Mailing Address - Zip Code:94565-1310
Mailing Address - Country:US
Mailing Address - Phone:628-235-7434
Mailing Address - Fax:
Practice Address - Street 1:285 DRIFTWOOD DR
Practice Address - Street 2:
Practice Address - City:BAY POINT
Practice Address - State:CA
Practice Address - Zip Code:94565-1310
Practice Address - Country:US
Practice Address - Phone:628-235-7434
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-06
Last Update Date:2019-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA103441122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist