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General NPI Number Information
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NPI Number | 1295410801
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Entity Type | Individual
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Provider Name | EMILY LISSETH MEJIA DDS
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Gender | Female
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Dates
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Enumeration Date | 06/20/2023
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Last Update Date | 06/20/2023
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Provider Practice Location Address
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Address Line | 2110 W SLAUGHTER LN STE 190
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City | AUSTIN
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State | TX
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Zip | 78748-5997
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Country | US
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Telephone | 512-593-4465
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Fax |
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Provider Business Mailing Address
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Address Line | 13112 POLLARD DR
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City | AUSTIN
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State | TX
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Zip | 78727-7023
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Country | US
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Telephone | 512-316-6136
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 39574
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License Number State | TX
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