Provider Demographics
NPI:1922551688
Name:MERCADO, ALEX
Entity Type:Individual
Prefix:
First Name:ALEX
Middle Name:
Last Name:MERCADO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1315 ALHAMBRA BLVD STE 220
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95816-5246
Mailing Address - Country:US
Mailing Address - Phone:916-448-5458
Mailing Address - Fax:916-446-7384
Practice Address - Street 1:1315 ALHAMBRA BLVD STE 220
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95816-5246
Practice Address - Country:US
Practice Address - Phone:916-448-5458
Practice Address - Fax:916-446-7384
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-29
Last Update Date:2019-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1004131223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice