Provider Demographics
NPI:1013536259
Name:MENENDEZ, VICTORIA JESSICA (DDS)
Entity Type:Individual
Prefix:DR
First Name:VICTORIA
Middle Name:JESSICA
Last Name:MENENDEZ
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1441 DRESDEN DR NE STE 250
Mailing Address - Street 2:
Mailing Address - City:BROOKHAVEN
Mailing Address - State:GA
Mailing Address - Zip Code:30319-3585
Mailing Address - Country:US
Mailing Address - Phone:404-254-1128
Mailing Address - Fax:
Practice Address - Street 1:1441 DRESDEN DR NE STE 250
Practice Address - Street 2:
Practice Address - City:BROOKHAVEN
Practice Address - State:GA
Practice Address - Zip Code:30319-3585
Practice Address - Country:US
Practice Address - Phone:404-254-1128
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-08
Last Update Date:2021-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN25679122300000X
390200000X
GADN122305122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program