Provider Demographics
NPI:1760776520
Name:MERCADO, MARIA DEL MAR (DMD)
Entity Type:Individual
Prefix:DR
First Name:MARIA DEL MAR
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:PASEOS DE LA REINA CALLE CALEZA T-18
Mailing Address - Street 2:
Mailing Address - City:ARECIBO
Mailing Address - State:PR
Mailing Address - Zip Code:00612
Mailing Address - Country:US
Mailing Address - Phone:787-236-4867
Mailing Address - Fax:
Practice Address - Street 1:ST. 111 AVE. LOS PATRIOTAS KM 33.2
Practice Address - Street 2:ZIEMA PROFESSIONAL PLAZA SUITE #7
Practice Address - City:LARES
Practice Address - State:PR
Practice Address - Zip Code:00669
Practice Address - Country:US
Practice Address - Phone:787-236-4867
Practice Address - Fax:787-236-4867
Is Sole Proprietor?:No
Enumeration Date:2011-06-08
Last Update Date:2020-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
PR3072122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program