Provider Demographics
NPI:1639295793
Name:MERCADO, DOLLY ESTABILLO (DDS)
Entity Type:Individual
Prefix:DR
First Name:DOLLY
Middle Name:ESTABILLO
Last Name:MERCADO
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:677B W TENNYSON RD
Mailing Address - Street 2:
Mailing Address - City:HAYWARD
Mailing Address - State:CA
Mailing Address - Zip Code:94544-5235
Mailing Address - Country:US
Mailing Address - Phone:510-887-8888
Mailing Address - Fax:510-887-1888
Practice Address - Street 1:677B W TENNYSON RD
Practice Address - Street 2:
Practice Address - City:HAYWARD
Practice Address - State:CA
Practice Address - Zip Code:94544-5235
Practice Address - Country:US
Practice Address - Phone:510-887-8888
Practice Address - Fax:510-887-1888
Is Sole Proprietor?:No
Enumeration Date:2007-03-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA483341223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice