Provider Demographics
NPI:1134685688
Name:ANNA M MENDOZA DDS INC
Entity Type:Organization
Organization Name:ANNA M MENDOZA DDS INC
Other - Org Name:AM DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANNA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:MENDOZA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:619-591-9222
Mailing Address - Street 1:3041 BONITA RD STE 101
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91910-3265
Mailing Address - Country:US
Mailing Address - Phone:619-591-9222
Mailing Address - Fax:619-591-9217
Practice Address - Street 1:3041 BONITA RD STE 101
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91910-3265
Practice Address - Country:US
Practice Address - Phone:619-591-9222
Practice Address - Fax:619-591-9217
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-20
Last Update Date:2019-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty