Provider Demographics
NPI:1750037107
Name:M.A. ORTHODONTICS, PLLC
Entity Type:Organization
Organization Name:M.A. ORTHODONTICS, PLLC
Other - Org Name:HARVEST GROVE ORTHODONTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/ORTHODONTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MECCA
Authorized Official - Middle Name:
Authorized Official - Last Name:ABDULLAH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:318-527-9767
Mailing Address - Street 1:525 YALE ST APT 308
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77007-2865
Mailing Address - Country:US
Mailing Address - Phone:318-527-9767
Mailing Address - Fax:
Practice Address - Street 1:11143 HARLEM RD.
Practice Address - Street 2:SUITE 480
Practice Address - City:RICHMOND
Practice Address - State:TX
Practice Address - Zip Code:77406
Practice Address - Country:US
Practice Address - Phone:281-942-0122
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-24
Last Update Date:2022-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty