Provider Demographics
NPI:1346596665
Name:MESA, TAHIMARA (DMD)
Entity Type:Individual
Prefix:
First Name:TAHIMARA
Middle Name:
Last Name:MESA
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:TAHIMARA
Other - Middle Name:
Other - Last Name:PEREZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD
Mailing Address - Street 1:2763S CONGRESS AVE
Mailing Address - Street 2:
Mailing Address - City:PALM SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33461-2137
Mailing Address - Country:US
Mailing Address - Phone:561-577-5647
Mailing Address - Fax:
Practice Address - Street 1:2763S CONGRESS AVE
Practice Address - Street 2:
Practice Address - City:PALM SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33461-2137
Practice Address - Country:US
Practice Address - Phone:561-577-5647
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-24
Last Update Date:2016-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN19855122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist