Healthcare Provider Details

I. General information

NPI: 1699826123
Provider Name (Legal Business Name): MARTHA MEJIA-MAIDL D.D.S., M.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/12/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 MCRAE BLVD
EL PASO TX
79925-6706
US

IV. Provider business mailing address

1800 MCRAE BLVD
EL PASO TX
79925-6706
US

V. Phone/Fax

Practice location:
  • Phone: 915-592-4168
  • Fax: 915-591-5014
Mailing address:
  • Phone: 915-592-4168
  • Fax: 915-591-5014

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number20351
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: