Gabrielle Elizabeth Mertz, DDS
Individual provider Active NPI Dentist · O Fallon, MO
NPI 1609765247 · NPPES record last updated Jun 30, 2025
Key facts
- NPI
- 1609765247
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- 2025022931 (MO)
- Practice address
- 3009 Highway K
O Fallon, MO 63368-8696 - Phone
- (636) 379-7552
- Fax
- (636) 379-7553
- NPI assigned
- Jun 30, 2025
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MO
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20250913000147 | MO | Order and Referring Only - Dentist |
7416450598 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2025022931 | MO | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Alex Sharifian DDS Ofallon Modern Dentistry PC | Past |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 2025022931 | MO | Yes |
Addresses
Primary practice location
3009 Highway K
O Fallon, MO 63368-8696
Mailing address
3009 Highway K
O Fallon, MO 63368-8696
Phone (636) 379-7552
Other providers in O Fallon, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 30, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.