Individual
DR. JAQUES GONTIJO MEZENCIO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
4901 E 42ND ST STE B, ODESSA, TX 79762-7338
(432) 242-8827
Mailing address
8645 VIA TAVOLERIA WAY, WINDERMERE, FL 34786-6828
(561) 843-4364
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
41088
TX
Other
Enumeration date
11/01/2024
Last updated
11/01/2024
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