Healthcare Provider Details

I. General information

NPI: 1558744342
Provider Name (Legal Business Name): ISABELLA MEJIA D.D.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/30/2015
Last Update Date: 04/09/2024
Certification Date: 04/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6760 ABRAMS RD STE 201
DALLAS TX
75231-0245
US

IV. Provider business mailing address

3212 BROOKSHIRE DR
PLANO TX
75075-4713
US

V. Phone/Fax

Practice location:
  • Phone: 469-890-1778
  • Fax:
Mailing address:
  • Phone: 972-801-7618
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number31136
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: