Provider Demographics
NPI:1881379683
Name:MEJIA, ANA MARIA
Entity type:Individual
Prefix:
First Name:ANA
Middle Name:MARIA
Last Name:MEJIA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9140 LAMONT AVE
Mailing Address - Street 2:APT 2H
Mailing Address - City:ELMHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11373-2762
Mailing Address - Country:US
Mailing Address - Phone:646-595-5582
Mailing Address - Fax:
Practice Address - Street 1:630 TOLLAND STAGE RD
Practice Address - Street 2:
Practice Address - City:TOLLAND
Practice Address - State:CT
Practice Address - Zip Code:06084-2924
Practice Address - Country:US
Practice Address - Phone:860-872-8551
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-19
Last Update Date:2023-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT138021223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice