Provider Demographics
NPI:1316210792
Name:KEVIN MENDES, D.D.S. & ASSOCIATES, P.L.L.C.
Entity Type:Organization
Organization Name:KEVIN MENDES, D.D.S. & ASSOCIATES, P.L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:C
Authorized Official - Last Name:MENDES
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:703-368-4725
Mailing Address - Street 1:8404 DORSEY CIR
Mailing Address - Street 2:
Mailing Address - City:MANASSAS
Mailing Address - State:VA
Mailing Address - Zip Code:20110-4592
Mailing Address - Country:US
Mailing Address - Phone:703-368-4725
Mailing Address - Fax:
Practice Address - Street 1:8404 DORSEY CIR
Practice Address - Street 2:
Practice Address - City:MANASSAS
Practice Address - State:VA
Practice Address - Zip Code:20110-4592
Practice Address - Country:US
Practice Address - Phone:703-368-4725
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-16
Last Update Date:2012-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014017821223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty