Provider Demographics
NPI:1902023583
Name:ROBERTS, MERCEDES (DDS)
Entity Type:Individual
Prefix:DR
First Name:MERCEDES
Middle Name:
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:MISS
Other - First Name:MERCEDES
Other - Middle Name:
Other - Last Name:LUTGENS LAZARTE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:130 E LELAND RD
Mailing Address - Street 2:SUITE D
Mailing Address - City:PITTSBURG
Mailing Address - State:CA
Mailing Address - Zip Code:94565-4983
Mailing Address - Country:US
Mailing Address - Phone:925-432-2995
Mailing Address - Fax:925-427-3091
Practice Address - Street 1:130 E LELAND RD
Practice Address - Street 2:SUITE D
Practice Address - City:PITTSBURG
Practice Address - State:CA
Practice Address - Zip Code:94565-4983
Practice Address - Country:US
Practice Address - Phone:925-432-2995
Practice Address - Fax:925-427-3091
Is Sole Proprietor?:No
Enumeration Date:2007-04-18
Last Update Date:2014-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA489851223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice