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General NPI Number Information
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NPI Number | 1679873764
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Entity Type | Organization
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Legal Business Name | FRANCISCO MESA DDS PA
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Dates
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Enumeration Date | 10/24/2010
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Last Update Date | 10/24/2010
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Provider Practice Location Address
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Address Line | 7727 FLYING CLOUD DR
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City | EDEN PRAIRIE
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State | MN
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Zip | 55344-3708
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Country | US
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Telephone | 608-215-6643
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Fax |
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Provider Business Mailing Address
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Address Line | 6496 BORDEAUX CT
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City | INVER GROVE HEIGHTS
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State | MN
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Zip | 55076-2057
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Country | US
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Telephone | 608-215-6643
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | DR. FRANCISCO J MESA
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Credential | DDS
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Telephone | 608-215-6643
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | D12189
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License Number State | MN
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