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General NPI Number Information
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NPI Number | 1467737312
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Entity Type | Organization
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Legal Business Name | MEJIA-MAIDL ORTHODONTICS, P.A.
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Dates
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Enumeration Date | 10/11/2011
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Last Update Date | 10/11/2011
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Provider Practice Location Address
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Address Line | 9130 VISCOUNT BLVD
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City | EL PASO
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State | TX
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Zip | 79925-6512
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Country | US
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Telephone | 915-500-5602
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Fax | 915-500-5604
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Provider Business Mailing Address
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Address Line | 9130 VISCOUNT BLVD
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City | EL PASO
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State | TX
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Zip | 79925-6512
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Country | US
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Telephone | 915-500-5602
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Fax | 915-500-5604
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MARTHA MEJIA-MAIDL
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Credential | D.D.S., M.S.
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Telephone | 915-500-5602
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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 | 20351
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License Number State | TX
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