Provider Demographics
NPI:1124217484
Name:MERCED, ALICIA A (DDS)
Entity type:Individual
Prefix:DR
First Name:ALICIA
Middle Name:A
Last Name:MERCED
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:87 SEAGULL COURT
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:CA
Mailing Address - Zip Code:94804-7408
Mailing Address - Country:US
Mailing Address - Phone:510-235-9505
Mailing Address - Fax:510-235-9432
Practice Address - Street 1:87 SEAGULL DR
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:CA
Practice Address - Zip Code:94804-7408
Practice Address - Country:US
Practice Address - Phone:510-235-9505
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-23
Last Update Date:2008-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA24723122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist