Provider Demographics
NPI:1760813232
Name:LEE CHARLES MERCER, JR
Entity type:Organization
Organization Name:LEE CHARLES MERCER, JR
Other - Org Name:<UNAVAIL>
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:76012-4698
Mailing Address - Country:US
Mailing Address - Phone:817-275-4817
Mailing Address - Fax:817-275-1765
Practice Address - Street 1:725 N FIELDER RD
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76012-4698
Practice Address - Country:US
Practice Address - Phone:817-275-4817
Practice Address - Fax:817-275-1765
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-09
Last Update Date:2013-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9945122300000X
TX29082122300000X
TX20975122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty