Provider Demographics
NPI:1841834348
Name:ADRIANA A. MERCADO C.
Entity type:Organization
Organization Name:ADRIANA A. MERCADO C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ADRIANA
Authorized Official - Middle Name:ALEJANDRA
Authorized Official - Last Name:MERCADO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:915-706-9953
Mailing Address - Street 1:409 ROSLYN DR.
Mailing Address - Street 2:
Mailing Address - City:HORIZON CITY
Mailing Address - State:TX
Mailing Address - Zip Code:79928
Mailing Address - Country:US
Mailing Address - Phone:915-706-9953
Mailing Address - Fax:858-430-3143
Practice Address - Street 1:AV. PLUTARCO ELIAS CALLES 779 NORTE
Practice Address - Street 2:COL. PROGRESISTA
Practice Address - City:CIUDAD JUAREZ
Practice Address - State:CHIHUAHUA
Practice Address - Zip Code:32310
Practice Address - Country:MX
Practice Address - Phone:915-706-9953
Practice Address - Fax:858-430-3143
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-29
Last Update Date:2020-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty