Healthcare Provider Details

I. General information

NPI: 1467551267
Provider Name (Legal Business Name): LILIANA MEJIA DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/21/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1550 ROCK QUARRY RD SUITE A
STOCKBRIDGE GA
30281-6326
US

IV. Provider business mailing address

1550 ROCK QUARRY RD SUITE A
STOCKBRIDGE GA
30281-6326
US

V. Phone/Fax

Practice location:
  • Phone: 770-389-8797
  • Fax: 770-389-0808
Mailing address:
  • Phone: 770-389-8797
  • Fax: 770-389-0808

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License NumberDN010642
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: