Provider Demographics
NPI:1083700298
Name:MONDRAGON, FRANCISCO (DDS)
Entity Type:Individual
Prefix:DR
First Name:FRANCISCO
Middle Name:
Last Name:MONDRAGON
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2832 SAVANNAH CT
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91914-4211
Mailing Address - Country:US
Mailing Address - Phone:619-407-4032
Mailing Address - Fax:
Practice Address - Street 1:180 OTAY LAKES RD
Practice Address - Street 2:SUITE 206
Practice Address - City:BONITA
Practice Address - State:CA
Practice Address - Zip Code:91902-2443
Practice Address - Country:US
Practice Address - Phone:619-475-8222
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA453931223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice