MEDICARE: DR. WANDA ESPERANZA MEJIA DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	048615	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1033122775
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. WANDA ESPERANZA MEJIA DDS

Provider Business Mailing Address
First Line	:	5295 ARLINGTON AVE
Second Line	:
City	:	BX
State	:	NY
Zip	:	10471
Country	:	US
Telephone Number	:	646-330-9412
Fax Number	:	914-526-2187

Provider Business Practice Location Address
First Line	:	1968 E. MAIN ST MOHEGAN LAKE NY 10547
Second Line	:
City	:	MOHEGAN LAKE
State	:	NY
Zip	:	10547
Country	:	US
Telephone Number	:	914-526-2144
Fax Number	:	914-526-2187

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/14/2006
Last Update Date	:	12/10/2024

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