Healthcare Provider Details

I. General information

NPI: 1184587271
Provider Name (Legal Business Name): EFREN MESA CARMONA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/04/2025
Last Update Date: 12/04/2025
Certification Date: 12/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23950 FRANZ RD STE 400
KATY TX
77493-5728
US

IV. Provider business mailing address

6118 LILLYBELLE ST
KATY TX
77449-2220
US

V. Phone/Fax

Practice location:
  • Phone: 832-437-5895
  • Fax:
Mailing address:
  • Phone: 832-519-4104
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number27954
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: