Provider Demographics
NPI:1861871170
Name:MERCY SEAT DENTISTRY
Entity type:Organization
Organization Name:MERCY SEAT DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NKECHI
Authorized Official - Middle Name:AWELE
Authorized Official - Last Name:WAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:260-823-3328
Mailing Address - Street 1:2155 COMMERCE DRIVE
Mailing Address - Street 2:
Mailing Address - City:BLUFFTON
Mailing Address - State:IN
Mailing Address - Zip Code:46714
Mailing Address - Country:US
Mailing Address - Phone:260-823-3328
Mailing Address - Fax:260-353-1555
Practice Address - Street 1:2155 COMMERCE DRIVE
Practice Address - Street 2:
Practice Address - City:BLUFFTON
Practice Address - State:IN
Practice Address - Zip Code:46714
Practice Address - Country:US
Practice Address - Phone:260-823-3328
Practice Address - Fax:260-353-1555
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-20
Last Update Date:2015-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
No124Q00000XDental ProvidersDental HygienistGroup - Multi-Specialty
No126800000XDental ProvidersDental AssistantGroup - Multi-Specialty