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Organization
MISTA DENTAL PLLC
Active
Organization
MISTA DENTAL PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MANGAYARKARASI MATHIYAZHAGAN (OWNER)
(210) 659-6622
Entity
Organization
Contact information
Practice address
8143 AGORA PKWY STE 105, SELMA, TX 78154-1357
(210) 659-6622
Mailing address
PO BOX 70887, CLEVELAND, OH 44190-0887
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Enumeration date
11/15/2022
Last updated
06/21/2023
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