Provider Demographics
NPI:1518190610
Name:MEZA-BAERTSCH, XIMENA (DDS)
Entity Type:Individual
Prefix:DR
First Name:XIMENA
Middle Name:
Last Name:MEZA-BAERTSCH
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:NOHORA
Other - Middle Name:XIMENA
Other - Last Name:MEZA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:15335 CASEY CIR
Mailing Address - Street 2:
Mailing Address - City:BROOKFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53005-4150
Mailing Address - Country:US
Mailing Address - Phone:262-627-0481
Mailing Address - Fax:
Practice Address - Street 1:1801 W WISCONSIN AVE STE 4
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53233-2186
Practice Address - Country:US
Practice Address - Phone:414-288-0787
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-08-24
Last Update Date:2016-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI249875122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist