Provider Demographics
NPI:1639215106
Name:MERCER, TIMOTHY CLAYTON (DMD)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:CLAYTON
Last Name:MERCER
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:PO BOX 154
Mailing Address - Street 2:
Mailing Address - City:TERRA CEIA
Mailing Address - State:FL
Mailing Address - Zip Code:34250-0154
Mailing Address - Country:US
Mailing Address - Phone:941-723-9909
Mailing Address - Fax:941-924-2067
Practice Address - Street 1:3590 WEBBER ST
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34239-4929
Practice Address - Country:US
Practice Address - Phone:941-922-1818
Practice Address - Fax:941-924-2067
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN-146241223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice