Provider Demographics
NPI:1225265697
Name:MENA, RAUL R (DMD)
Entity Type:Individual
Prefix:DR
First Name:RAUL
Middle Name:R
Last Name:MENA
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 N. UNIVERSITY DR.
Mailing Address - Street 2:#101
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33324
Mailing Address - Country:US
Mailing Address - Phone:954-474-4707
Mailing Address - Fax:954-474-4707
Practice Address - Street 1:201 N UNIVERSITY DR
Practice Address - Street 2:#101
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33324-2039
Practice Address - Country:US
Practice Address - Phone:954-474-4707
Practice Address - Fax:954-474-4707
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-12
Last Update Date:2009-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL6919122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist