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General NPI Number Information
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NPI Number | 1679643415
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Entity Type | Organization
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Legal Business Name | OCTAVIO MEJIA JR DDS
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Dates
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Enumeration Date | 11/09/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2103 E GRIFFIN PARKWAY SUITE A
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City | MISSION
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State | TX
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Zip | 78572
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Country | US
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Telephone | 956-583-9880
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Fax | 956-583-1383
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Provider Business Mailing Address
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Address Line | 2103 E GRIFFIN PARKWAY SUITE A
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City | MISSION
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State | TX
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Zip | 78572
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Country | US
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Telephone | 956-583-9880
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Fax | 956-583-1383
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Authorized Official
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Title or Position | OWNER
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Name | DR. OCTAVIO MEJIA JR.
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Credential | DDS
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Telephone | 956-583-9880
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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 | 19615
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License Number State | TX
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