Provider Demographics
NPI:1588395131
Name:AGYEMFRA, MERCEDEZ G (DDS, MPH)
Entity type:Individual
Prefix:DR
First Name:MERCEDEZ
Middle Name:G
Last Name:AGYEMFRA
Suffix:
Gender:F
Credentials:DDS, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 BALDER RD
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01605-3807
Mailing Address - Country:US
Mailing Address - Phone:508-762-8823
Mailing Address - Fax:
Practice Address - Street 1:20 BALDER RD
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01605-3807
Practice Address - Country:US
Practice Address - Phone:508-762-8823
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-23
Last Update Date:2023-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN1859533122300000X
GADN1228581223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist