Provider Demographics
NPI:1659891190
Name:MERCADO, KATHERINE (DMD)
Entity Type:Individual
Prefix:DR
First Name:KATHERINE
Middle Name:
Last Name:MERCADO
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14721 SW 39TH TER
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33185-4970
Mailing Address - Country:US
Mailing Address - Phone:305-733-0808
Mailing Address - Fax:
Practice Address - Street 1:10201 HAMMOCKS BLVD STE 146
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33196-3785
Practice Address - Country:US
Practice Address - Phone:305-382-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-26
Last Update Date:2021-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL22693122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist