Provider Demographics
NPI:1427199983
Name:MENDOZA, ISRAEL RUBEN (DDS)
Entity Type:Individual
Prefix:DR
First Name:ISRAEL
Middle Name:RUBEN
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 1:11507 ALLECINGIE PKWY
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23235-4301
Mailing Address - Country:US
Mailing Address - Phone:804-379-9375
Mailing Address - Fax:804-379-3913
Practice Address - Street 1:11507 ALLECINGIE PKWY
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23235-4301
Practice Address - Country:US
Practice Address - Phone:804-379-9375
Practice Address - Fax:804-379-3913
Is Sole Proprietor?:No
Enumeration Date:2007-02-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice