Organization
ADVANCED AESTHETIC DENTISTRY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. WANDA E MEJIA D.D.S. (DENTIST)
(914) 526-2144
Entity
Organization
Contact information
Practice address
3244 E MAIN ST, MOHEGAN LAKE, NY 10547-1535
(914) 526-2144
(914) 523-2187
Mailing address
3244 E MAIN ST, MOHEGAN LAKE, NY 10547-1535
(914) 526-2144
(914) 523-2187
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
048450
NY
1223G0001X
General Practice Dentistry
048615
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
048450
DENTIST LIC #
NY
01
—
048615
DENTIST LIC #
NY
Enumeration date
05/24/2007
Last updated
08/22/2020
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