Provider Demographics
NPI:1356374375
Name:TERESA TRAN MERCADO, DDS DENTAL CORPORATION
Entity type:Organization
Organization Name:TERESA TRAN MERCADO, DDS DENTAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:TRAN
Authorized Official - Last Name:MERCADO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:510-656-4400
Mailing Address - Street 1:5866 MOWRY SCHOOL RD
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:CA
Mailing Address - Zip Code:94560-5367
Mailing Address - Country:US
Mailing Address - Phone:510-656-4400
Mailing Address - Fax:
Practice Address - Street 1:5866 MOWRY SCHOOL RD
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:CA
Practice Address - Zip Code:94560-5367
Practice Address - Country:US
Practice Address - Phone:510-656-4400
Practice Address - Fax:510-656-4494
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-10
Last Update Date:2008-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA450431223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty