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General NPI Number Information
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NPI Number | 1558819615
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Entity Type | Organization
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Legal Business Name | EDUARDO A MEJIA DDS PA
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Dates
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Enumeration Date | 09/19/2016
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Last Update Date | 01/31/2017
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Provider Practice Location Address
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Address Line | 2257 N LOOP 336 W STE 120
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City | CONROE
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State | TX
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Zip | 77304-3566
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Country | US
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Telephone | 936-588-9303
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Fax | 936-756-9393
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Provider Business Mailing Address
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Address Line | 2257 N LOOP 336 W STE 120
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City | CONROE
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State | TX
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Zip | 77304-3566
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Country | US
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Telephone | 936-588-9303
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Fax | 936-756-9393
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Authorized Official
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Title or Position | OWNER
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Name | DR. EDUARDO A. MEJIA
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Credential |
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Telephone | 936-588-9303
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332BC3200X
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Taxonomy Name | Customized Equipment (DME)
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 22766
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License Number State | TX
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