Provider Demographics
NPI:1689783896
Name:MERCADO, BRUCE PHILIP (DDS)
Entity Type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:PHILIP
Last Name:MERCADO
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6445 CITATION DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:CLARKSTON
Mailing Address - State:MI
Mailing Address - Zip Code:48346-2996
Mailing Address - Country:US
Mailing Address - Phone:248-625-5000
Mailing Address - Fax:
Practice Address - Street 1:6445 CITATION DR
Practice Address - Street 2:SUITE A
Practice Address - City:CLARKSTON
Practice Address - State:MI
Practice Address - Zip Code:48346-2996
Practice Address - Country:US
Practice Address - Phone:248-625-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010135451223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice