Provider Demographics
NPI:1205294220
Name:MEJIA DENTAL CORPORATION
Entity type:Organization
Organization Name:MEJIA DENTAL CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JAVIER
Authorized Official - Middle Name:
Authorized Official - Last Name:MEJIA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:760-408-6883
Mailing Address - Street 1:45841 OASIS ST STE 3
Mailing Address - Street 2:
Mailing Address - City:INDIO
Mailing Address - State:CA
Mailing Address - Zip Code:92201-4505
Mailing Address - Country:US
Mailing Address - Phone:760-408-6883
Mailing Address - Fax:760-342-0808
Practice Address - Street 1:45841 OASIS ST STE 3
Practice Address - Street 2:
Practice Address - City:INDIO
Practice Address - State:CA
Practice Address - Zip Code:92201-4505
Practice Address - Country:US
Practice Address - Phone:760-408-6883
Practice Address - Fax:760-342-0808
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-04
Last Update Date:2016-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA49779122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty