Provider Demographics
NPI:1972679603
Name:ULIT, MARILOU MERCADO (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARILOU
Middle Name:MERCADO
Last Name:ULIT
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2105 BEVERLY BLVD
Mailing Address - Street 2:SUITE #125
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90057
Mailing Address - Country:US
Mailing Address - Phone:213-413-8766
Mailing Address - Fax:213-383-9375
Practice Address - Street 1:2105 BEVERLY BLVD
Practice Address - Street 2:SUITE #125
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90057
Practice Address - Country:US
Practice Address - Phone:213-413-8766
Practice Address - Fax:213-383-9375
Is Sole Proprietor?:No
Enumeration Date:2006-11-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA38091122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist