Individual
GEORGINA MESA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DMD
Contact information
Practice address
1878 SW 57 AVE, MIAMI, FL 33155
(305) 262-9299
(305) 262-8772
Mailing address
13550 SW 120TH ST, STE 512, MIAMI, FL 33186-7507
(305) 380-7000
(786) 227-5315
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
DN0013428
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
075011500
—
FL
01
—
36710
BLUE CROSS BLUE SHIELD
FL
01
—
979361
UNITED CONCORDIA
FL
Enumeration date
11/01/2006
Last updated
03/07/2016
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