Healthcare Provider Details

I. General information

NPI: 1457550683
Provider Name (Legal Business Name): LUZ ELENA MEJIA DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/17/2007
Last Update Date: 07/17/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 APPALOOSA WAY
COLD SPRING NY
10516-4363
US

IV. Provider business mailing address

46 FOX ST SUITE 1
POUGHKEEPSIE NY
12601-4703
US

V. Phone/Fax

Practice location:
  • Phone: 845-809-5017
  • Fax:
Mailing address:
  • Phone: 845-473-3636
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number049295
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: