Provider Demographics
NPI:1467737312
Name:MEJIA-MAIDL ORTHODONTICS, P.A.
Entity Type:Organization
Organization Name:MEJIA-MAIDL ORTHODONTICS, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARTHA
Authorized Official - Middle Name:
Authorized Official - Last Name:MEJIA-MAIDL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MS
Authorized Official - Phone:915-500-5602
Mailing Address - Street 1:9130 VISCOUNT BLVD
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79925-6512
Mailing Address - Country:US
Mailing Address - Phone:915-500-5602
Mailing Address - Fax:915-500-5604
Practice Address - Street 1:9130 VISCOUNT BLVD
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79925-6512
Practice Address - Country:US
Practice Address - Phone:915-500-5602
Practice Address - Fax:915-500-5604
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-11
Last Update Date:2011-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX20351122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty