Provider Demographics
NPI:1225117690
Name:MEJIA, FRANCISCO JOSE (DDS)
Entity Type:Individual
Prefix:DR
First Name:FRANCISCO
Middle Name:JOSE
Last Name:MEJIA
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 1ST AVE
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:NY
Mailing Address - Zip Code:11717-4602
Mailing Address - Country:US
Mailing Address - Phone:631-231-3336
Mailing Address - Fax:631-231-8992
Practice Address - Street 1:18 1ST AVE
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:NY
Practice Address - Zip Code:11717-4602
Practice Address - Country:US
Practice Address - Phone:631-231-3336
Practice Address - Fax:631-231-8992
Is Sole Proprietor?:No
Enumeration Date:2006-11-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0302771223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00287274Medicaid