Provider Demographics
NPI:1477320984
Name:MEDINA, GEORGINA (DDS)
Entity Type:Individual
Prefix:
First Name:GEORGINA
Middle Name:
Last Name:MEDINA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13042 MEMORIAL DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77079-7324
Mailing Address - Country:US
Mailing Address - Phone:956-793-4065
Mailing Address - Fax:
Practice Address - Street 1:13042 MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77079-7324
Practice Address - Country:US
Practice Address - Phone:956-793-4065
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-05
Last Update Date:2023-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX401611223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice