Provider Demographics
NPI:1902002017
Name:MERCADO, FLORENTINA MAGCANAM (DDS)
Entity Type:Individual
Prefix:
First Name:FLORENTINA
Middle Name:MAGCANAM
Last Name:MERCADO
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38850 FARWELL DR APT 2A
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94536-7258
Mailing Address - Country:US
Mailing Address - Phone:510-282-8704
Mailing Address - Fax:510-744-9164
Practice Address - Street 1:1153 N LAWRENCE EXPY
Practice Address - Street 2:
Practice Address - City:SUNNYVALE
Practice Address - State:CA
Practice Address - Zip Code:94089-2025
Practice Address - Country:US
Practice Address - Phone:408-541-1900
Practice Address - Fax:408-541-1588
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA504931223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice