Provider Demographics
NPI:1710998158
Name:MERCURIO, JOHN F JR (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:F
Last Name:MERCURIO
Suffix:JR
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 1:191 WEST HOFFMAN AVE
Mailing Address - Street 2:
Mailing Address - City:LINDENHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11757-4036
Mailing Address - Country:US
Mailing Address - Phone:631-226-2333
Mailing Address - Fax:631-226-2386
Practice Address - Street 1:191 WEST HOFFMAN AVE
Practice Address - Street 2:
Practice Address - City:LINDENHURST
Practice Address - State:NY
Practice Address - Zip Code:11757-4036
Practice Address - Country:US
Practice Address - Phone:631-226-2333
Practice Address - Fax:631-226-2386
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2017-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY338981223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice