Provider Demographics
NPI:1225136260
Name:MENTESANA, CARL (DDS)
Entity Type:Individual
Prefix:DR
First Name:CARL
Middle Name:
Last Name:MENTESANA
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 1:9900 N CENTRAL EXPY
Mailing Address - Street 2:SUITE # 350
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75231-4395
Mailing Address - Country:US
Mailing Address - Phone:214-692-7800
Mailing Address - Fax:
Practice Address - Street 1:9900 N CENTRAL EXPY
Practice Address - Street 2:SUITE # 350
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231-4395
Practice Address - Country:US
Practice Address - Phone:214-692-7800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX128661223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice