Provider Demographics
NPI:1891830279
Name:MERTA, ALAN D (DDS)
Entity Type:Individual
Prefix:DR
First Name:ALAN
Middle Name:D
Last Name:MERTA
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 1:1601 E ALTON GLOOR BLVD
Mailing Address - Street 2:STE. 108
Mailing Address - City:BROWNSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78526-3902
Mailing Address - Country:US
Mailing Address - Phone:956-621-3333
Mailing Address - Fax:956-621-3336
Practice Address - Street 1:1601 E ALTON GLOOR BLVD
Practice Address - Street 2:STE. 108
Practice Address - City:BROWNSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78526-3902
Practice Address - Country:US
Practice Address - Phone:956-621-3333
Practice Address - Fax:956-621-3336
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2016-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX227781223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX180642404Medicaid
TXD22778OtherTEXAS CHIP
TX205292984OtherFEDERAL TAX ID