Healthcare Provider Details

I. General information

NPI: 1205294220
Provider Name (Legal Business Name): MEJIA DENTAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/04/2016
Last Update Date: 02/04/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45841 OASIS ST STE 3
INDIO CA
92201-4505
US

IV. Provider business mailing address

45841 OASIS ST STE 3
INDIO CA
92201-4505
US

V. Phone/Fax

Practice location:
  • Phone: 760-408-6883
  • Fax: 760-342-0808
Mailing address:
  • Phone: 760-408-6883
  • Fax: 760-342-0808

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number49779
License Number StateCA

VIII. Authorized Official

Name: DR. JAVIER MEJIA
Title or Position: DENTIST
Credential: DDS
Phone: 760-408-6883