Healthcare Provider Details

I. General information

NPI: 1740397009
Provider Name (Legal Business Name): RICHARD S MEJIA DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2006
Last Update Date: 05/25/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2145 5TH AVENUE
OROVILLE CA
95965
US

IV. Provider business mailing address

2145 5TH AVENUE
OROVILLE CA
95965
US

V. Phone/Fax

Practice location:
  • Phone: 530-534-3793
  • Fax: 530-534-3820
Mailing address:
  • Phone: 530-534-3793
  • Fax: 530-534-3820

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number33495
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: