Provider Demographics
NPI:1265606651
Name:MERCADO, MICHAEL MATTHEW (DDS)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:MATTHEW
Last Name:MERCADO
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 1:108 OLD SOLOMONS ISLAND RD
Mailing Address - Street 2:SUITE U-10
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21401-3845
Mailing Address - Country:US
Mailing Address - Phone:410-573-0888
Mailing Address - Fax:410-573-0930
Practice Address - Street 1:108 OLD SOLOMONS ISLAND RD
Practice Address - Street 2:SUITE U-10
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-3845
Practice Address - Country:US
Practice Address - Phone:410-573-0888
Practice Address - Fax:410-573-0930
Is Sole Proprietor?:No
Enumeration Date:2008-04-16
Last Update Date:2008-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD59791223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice