Provider Demographics
NPI:1679572424
Name:MERCER, RICHARD D (DMD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:D
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 1:700 NE MULTNOMAH ST
Mailing Address - Street 2:#830
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97232-2131
Mailing Address - Country:US
Mailing Address - Phone:503-238-0880
Mailing Address - Fax:503-238-0886
Practice Address - Street 1:700 NE MULTNOMAH ST
Practice Address - Street 2:#830
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97232-2131
Practice Address - Country:US
Practice Address - Phone:503-238-0880
Practice Address - Fax:503-238-0886
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD6417122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist