Provider Demographics
NPI:1639252406
Name:MERCER, LEE CHARLES JR (DDS)
Entity Type:Individual
Prefix:
First Name:LEE
Middle Name:CHARLES
Last Name:MERCER
Suffix:JR
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:CHIP
Other - Middle Name:
Other - Last Name:MERCER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:725 N FIELDER RD SUITE B
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76012
Mailing Address - Country:US
Mailing Address - Phone:817-275-4817
Mailing Address - Fax:817-275-1765
Practice Address - Street 1:725 N FIELDER RD SUITE B
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76012
Practice Address - Country:US
Practice Address - Phone:817-275-4817
Practice Address - Fax:817-275-1765
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX209751223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice