Provider Demographics
NPI:1679031538
Name:CORTES-MERCADO, JOHANA IVELISSE (DMD, MSD)
Entity type:Individual
Prefix:DR
First Name:JOHANA
Middle Name:IVELISSE
Last Name:CORTES-MERCADO
Suffix:
Gender:F
Credentials:DMD, MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:355 ESSEX ST
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:MA
Mailing Address - Zip Code:01840-1410
Mailing Address - Country:US
Mailing Address - Phone:978-794-0000
Mailing Address - Fax:
Practice Address - Street 1:355 ESSEX ST
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:MA
Practice Address - Zip Code:01840-1410
Practice Address - Country:US
Practice Address - Phone:978-794-0000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-08
Last Update Date:2024-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN100000291223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics