Provider Demographics
NPI:1508211244
Name:MEJU, MARKQUADA (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARKQUADA
Middle Name:
Last Name:MEJU
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:MARKQUADA
Other - Middle Name:
Other - Last Name:HAMILTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7001 CORPORATE DR STE 120
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77036-5113
Mailing Address - Country:US
Mailing Address - Phone:713-773-0803
Mailing Address - Fax:
Practice Address - Street 1:14438 BELLAIRE BLVD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77083-7520
Practice Address - Country:US
Practice Address - Phone:713-773-0803
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-02
Last Update Date:2023-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY390200000X
TX328191223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program