Provider Demographics
NPI:1326252982
Name:MENTESANA, CATHERINE SUSANN (DDS)
Entity Type:Individual
Prefix:
First Name:CATHERINE
Middle Name:SUSANN
Last Name:MENTESANA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:604 W BETHANY DR
Mailing Address - Street 2:STE. 210
Mailing Address - City:ALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:75013-3720
Mailing Address - Country:US
Mailing Address - Phone:972-747-1996
Mailing Address - Fax:
Practice Address - Street 1:604 W BETHANY DR
Practice Address - Street 2:STE. 210
Practice Address - City:ALLEN
Practice Address - State:TX
Practice Address - Zip Code:75013-3720
Practice Address - Country:US
Practice Address - Phone:972-747-1996
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-10
Last Update Date:2010-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX20453122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist