Provider Demographics
NPI:1396201778
Name:M DENTAL GRANBURY, PLLC
Entity type:Organization
Organization Name:M DENTAL GRANBURY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LEE
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:MERCER
Authorized Official - Suffix:JR
Authorized Official - Credentials:DDS
Authorized Official - Phone:817-275-4817
Mailing Address - Street 1:725 N FIELDER RD
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76012-4636
Mailing Address - Country:US
Mailing Address - Phone:817-275-4817
Mailing Address - Fax:
Practice Address - Street 1:500 W PEARL ST
Practice Address - Street 2:
Practice Address - City:GRANBURY
Practice Address - State:TX
Practice Address - Zip Code:76048-2044
Practice Address - Country:US
Practice Address - Phone:817-275-4817
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-11
Last Update Date:2019-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental