Individual provider Active NPI

Gabrielle Elizabeth Mertz, DDS

  • Dentist
  • O'Fallon, MO
National Provider Identifier
1609765247
Registry record updated Jun 30, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
2025022931 Issued in MO
Practice address
3009 Highway K
O Fallon, MO 63368-8696
Phone
(636) 379-7552
Fax
(636) 379-7553
NPI assigned
Jun 30, 2025
Last updated
Jun 30, 2025By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 30, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X 2025022931 MO Primary

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

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20250913000147 MO Order and Referring Only - DentistPractitioner - Dentist 7416450598

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
2025022931MOMDDentist

Practice roles

OrganizationSpecialtyStatusNew patients
Alex Sharifian DDS Ofallon Modern Dentistry PC PastSince Jul 9, 2025 Accepting new patients

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1751241600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1751241600000",
    "number": "1609765247",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3009 HIGHWAY K",
            "city": "O FALLON",
            "state": "MO",
            "postal_code": "633688696",
            "telephone_number": "636-379-7552",
            "fax_number": "636-379-7553"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3009 HIGHWAY K",
            "city": "O FALLON",
            "state": "MO",
            "postal_code": "633688696",
            "telephone_number": "636-379-7552",
            "fax_number": "636-379-7553"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MERTZ",
        "first_name": "GABRIELLE",
        "middle_name": "ELIZABETH",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2025-06-30",
        "last_updated": "2025-06-30",
        "certification_date": "2025-06-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "MO",
            "license": "2025022931",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in O'Fallon, MO

Sources for this page

Verify at the official NPI Registry.