Provider Demographics
NPI:1053625129
Name:MEJIA, DINA ROSE (DMD)
Entity type:Individual
Prefix:DR
First Name:DINA
Middle Name:ROSE
Last Name:MEJIA
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:DINA
Other - Middle Name:ROSE
Other - Last Name:MARGALLO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4127 GAGE AVE
Mailing Address - Street 2:
Mailing Address - City:BELL
Mailing Address - State:CA
Mailing Address - Zip Code:90201-1128
Mailing Address - Country:US
Mailing Address - Phone:213-949-2725
Mailing Address - Fax:
Practice Address - Street 1:4127 GAGE AVE
Practice Address - Street 2:
Practice Address - City:BELL
Practice Address - State:CA
Practice Address - Zip Code:90201-1128
Practice Address - Country:US
Practice Address - Phone:213-949-2725
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-01
Last Update Date:2021-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA59095122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist