Provider Demographics
NPI:1326416587
Name:MENA, ANGELICA ESTHER (DDS)
Entity Type:Individual
Prefix:
First Name:ANGELICA
Middle Name:ESTHER
Last Name:MENA
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 1:14501 GREATER PINES BLVD
Mailing Address - Street 2:
Mailing Address - City:CLERMONT
Mailing Address - State:FL
Mailing Address - Zip Code:34711-6561
Mailing Address - Country:US
Mailing Address - Phone:202-999-8360
Mailing Address - Fax:
Practice Address - Street 1:14501 GREATER PINES BLVD
Practice Address - Street 2:
Practice Address - City:CLERMONT
Practice Address - State:FL
Practice Address - Zip Code:34711-6561
Practice Address - Country:US
Practice Address - Phone:202-999-8360
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-04
Last Update Date:2023-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD159691223G0001X
FLDN255321223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice