Provider Demographics
NPI:1730758947
Name:MESA, EDDY (DDS)
Entity type:Individual
Prefix:
First Name:EDDY
Middle Name:
Last Name:MESA
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 1:13307 HIGH STAR DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77083-1907
Mailing Address - Country:US
Mailing Address - Phone:832-618-0493
Mailing Address - Fax:
Practice Address - Street 1:2708 PEARLAND PKWY STE 220
Practice Address - Street 2:
Practice Address - City:PEARLAND
Practice Address - State:TX
Practice Address - Zip Code:77581-5353
Practice Address - Country:US
Practice Address - Phone:281-997-1943
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-22
Last Update Date:2021-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX37304122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist