Provider Demographics
NPI:1225604754
Name:MEJIAS, RANDY (DMD)
Entity Type:Individual
Prefix:DR
First Name:RANDY
Middle Name:
Last Name:MEJIAS
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8206 WOODMONT CIR
Mailing Address - Street 2:
Mailing Address - City:MACUNGIE
Mailing Address - State:PA
Mailing Address - Zip Code:18062-8684
Mailing Address - Country:US
Mailing Address - Phone:786-444-1256
Mailing Address - Fax:
Practice Address - Street 1:327 S AVALON PARK BLVD
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32828-6781
Practice Address - Country:US
Practice Address - Phone:321-710-3435
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-03
Last Update Date:2021-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN253961223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice