Individual
MARCUS MERCER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
5526 E LAKE DR, LISLE, IL 60532-2691
(630) 373-6309
Mailing address
5526 E LAKE DR, LISLE, IL 60532-2691
(630) 373-6309
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
019.018685
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
019.018685
STATE OF ILLINOIS
IL
Enumeration date
10/12/2017
Last updated
06/16/2018
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