Healthcare Provider Details

I. General information

NPI: 1043547730
Provider Name (Legal Business Name): LINA MARIA MEJIA D.D.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/17/2009
Last Update Date: 11/17/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3200 S UNIVERSITY DR HPD- COLLEGE OF DENTAL MEDICINE
DAVIE FL
33328-2018
US

IV. Provider business mailing address

3200 S UNIVERSITY DR HPD- COLLEGE OF DENTAL MEDICINE
DAVIE FL
33328-2018
US

V. Phone/Fax

Practice location:
  • Phone: 954-262-1637
  • Fax:
Mailing address:
  • Phone: 954-262-1637
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0106X
TaxonomyOral and Maxillofacial Pathology Dentistry
License Number525
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: