Provider Demographics
NPI:1669512695
Name:MEJIA, JAVIER A (DDS)
Entity type:Individual
Prefix:MR
First Name:JAVIER
Middle Name:A
Last Name:MEJIA
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3591 PRIMROSE CIRCLE
Mailing Address - Street 2:
Mailing Address - City:SEAL BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90740-3128
Mailing Address - Country:US
Mailing Address - Phone:310-499-3111
Mailing Address - Fax:
Practice Address - Street 1:3591 PRIMROSE CIRCLE
Practice Address - Street 2:
Practice Address - City:SEAL BEACH
Practice Address - State:CA
Practice Address - Zip Code:90740
Practice Address - Country:US
Practice Address - Phone:310-499-3111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-07
Last Update Date:2016-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA49779122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist