Provider Demographics
NPI:1306051503
Name:MERCER, SHIRLEY DAUGHTERS (DDS)
Entity type:Individual
Prefix:MRS
First Name:SHIRLEY
Middle Name:DAUGHTERS
Last Name:MERCER
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 1:9333 BASELINE ROAD
Mailing Address - Street 2:STE #200
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91730
Mailing Address - Country:US
Mailing Address - Phone:909-980-5558
Mailing Address - Fax:909-980-3688
Practice Address - Street 1:9333 BASELINE ROAD
Practice Address - Street 2:STE #200
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730
Practice Address - Country:US
Practice Address - Phone:909-980-5558
Practice Address - Fax:909-980-3688
Is Sole Proprietor?:No
Enumeration Date:2007-05-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA0324881223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice