MEDICARE: IVELISSE MEJIA RIMA 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	1223G0001X	General Practice Dentistry

General Provider Information

NPI Number	:	1265306930
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	IVELISSE MEJIA RIMA DDS

Provider Business Mailing Address
First Line	:	3715 87TH ST FL 2
Second Line	:
City	:	JACKSON HEIGHTS
State	:	NY
Zip	:	11372-7534
Country	:	US
Telephone Number	:	718-476-9244
Fax Number	:	718-651-3814

Provider Business Practice Location Address
First Line	:	3715 87TH ST FL 2
Second Line	:
City	:	JACKSON HEIGHTS
State	:	NY
Zip	:	11372-7534
Country	:	US
Telephone Number	:	718-476-9244
Fax Number	:	718-651-3814

Authorized Official
Title or Position	:	BUSINESS OWNER
Name	:	DR. IVELISSE MEJIA RIMA
Credential	:	DDS
Telephone Number	:	718-476-9244

Provider Enumeration Date	:	10/03/2025
Last Update Date	:	10/03/2025

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