Provider Demographics
NPI:1235346859
Name:MENDOZA, DANIEL B (DDS)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:B
Last Name:MENDOZA
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 1:133 ARCH ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:REDWOOD CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94062-1379
Mailing Address - Country:US
Mailing Address - Phone:650-474-0932
Mailing Address - Fax:650-474-0938
Practice Address - Street 1:133 ARCH ST
Practice Address - Street 2:SUITE 1
Practice Address - City:REDWOOD CITY
Practice Address - State:CA
Practice Address - Zip Code:94062-1379
Practice Address - Country:US
Practice Address - Phone:650-474-0932
Practice Address - Fax:650-474-0938
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA326771223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice