Provider Demographics
NPI:1457550683
Name:MEJIA, LUZ ELENA (DDS)
Entity Type:Individual
Prefix:DR
First Name:LUZ
Middle Name:ELENA
Last Name:MEJIA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:46 FOX ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:POUGHKEEPSIE
Mailing Address - State:NY
Mailing Address - Zip Code:12601-4703
Mailing Address - Country:US
Mailing Address - Phone:845-473-3636
Mailing Address - Fax:
Practice Address - Street 1:3 APPALOOSA WAY
Practice Address - Street 2:
Practice Address - City:COLD SPRING
Practice Address - State:NY
Practice Address - Zip Code:10516-4363
Practice Address - Country:US
Practice Address - Phone:845-809-5017
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-17
Last Update Date:2007-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY049295122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist