Provider Demographics
NPI:1851835516
Name:MEJIA VENTURA, JAIRO (CDA)
Entity Type:Individual
Prefix:
First Name:JAIRO
Middle Name:
Last Name:MEJIA VENTURA
Suffix:
Gender:M
Credentials:CDA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5109 LEESBURG PIKE
Mailing Address - Street 2:SUITE 504
Mailing Address - City:FALLS CHURCH
Mailing Address - State:VA
Mailing Address - Zip Code:22041-3215
Mailing Address - Country:US
Mailing Address - Phone:703-882-3999
Mailing Address - Fax:
Practice Address - Street 1:5109 LEESBURG PIKE
Practice Address - Street 2:SUITE 504
Practice Address - City:FALLS CHURCH
Practice Address - State:VA
Practice Address - Zip Code:22041-3215
Practice Address - Country:US
Practice Address - Phone:703-882-3999
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-12-14
Last Update Date:2016-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes126800000XDental ProvidersDental Assistant