Provider Demographics
NPI:1740074889
Name:MYSOUL DENTAL GROUP MESA EP, PLLC
Entity type:Organization
Organization Name:MYSOUL DENTAL GROUP MESA EP, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MINYOUNG
Authorized Official - Middle Name:
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:626-807-8111
Mailing Address - Street 1:3712 GRAND BAHAMAS DR
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79936-2171
Mailing Address - Country:US
Mailing Address - Phone:626-807-8111
Mailing Address - Fax:
Practice Address - Street 1:7955 N MESA ST STE A
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79932-1625
Practice Address - Country:US
Practice Address - Phone:626-807-8111
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-04-05
Last Update Date:2025-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental