Provider Demographics
NPI:1720610413
Name:MEJIA, ELSA JOHANA (DENTAL ASSISTANT)
Entity Type:Individual
Prefix:
First Name:ELSA
Middle Name:JOHANA
Last Name:MEJIA
Suffix:
Gender:F
Credentials:DENTAL ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6255 SHARLANDS AVE STE 3
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89523-3729
Mailing Address - Country:US
Mailing Address - Phone:775-339-3015
Mailing Address - Fax:702-947-4803
Practice Address - Street 1:6255 SHARLANDS AVE STE 3
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89523-3729
Practice Address - Country:US
Practice Address - Phone:775-339-3015
Practice Address - Fax:702-947-4803
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-10
Last Update Date:2020-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes126800000XDental ProvidersDental Assistant