Provider Demographics
NPI:1477237998
Name:FERRUFINO-MEJIA, ELVYS (DDS)
Entity Type:Individual
Prefix:
First Name:ELVYS
Middle Name:
Last Name:FERRUFINO-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 1:406 CEDAR CHASE DR
Mailing Address - Street 2:
Mailing Address - City:WEST MEMPHIS
Mailing Address - State:AR
Mailing Address - Zip Code:72301-2978
Mailing Address - Country:US
Mailing Address - Phone:479-622-3119
Mailing Address - Fax:
Practice Address - Street 1:940 CHURCH RD W
Practice Address - Street 2:
Practice Address - City:SOUTHAVEN
Practice Address - State:MS
Practice Address - Zip Code:38671-9611
Practice Address - Country:US
Practice Address - Phone:662-253-8027
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-14
Last Update Date:2023-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS4388-23122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist