Provider Demographics
NPI:1679643415
Name:OCTAVIO MEJIA JR DDS
Entity Type:Organization
Organization Name:OCTAVIO MEJIA JR DDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:OCTAVIO
Authorized Official - Middle Name:
Authorized Official - Last Name:MEJIA
Authorized Official - Suffix:JR
Authorized Official - Credentials:DDS
Authorized Official - Phone:956-583-9880
Mailing Address - Street 1:2103 E GRIFFIN PARKWAY
Mailing Address - Street 2:SUITE A
Mailing Address - City:MISSION
Mailing Address - State:TX
Mailing Address - Zip Code:78572
Mailing Address - Country:US
Mailing Address - Phone:956-583-9880
Mailing Address - Fax:956-583-1383
Practice Address - Street 1:2103 E GRIFFIN PARKWAY
Practice Address - Street 2:SUITE A
Practice Address - City:MISSION
Practice Address - State:TX
Practice Address - Zip Code:78572
Practice Address - Country:US
Practice Address - Phone:956-583-9880
Practice Address - Fax:956-583-1383
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX19615122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
B19615OtherCHIP