Provider Demographics
NPI:1457843799
Name:MENDOZA, KRISTOPHER (DDS)
Entity Type:Individual
Prefix:DR
First Name:KRISTOPHER
Middle Name:
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 1:811 BRICKYARD CIR # A
Mailing Address - Street 2:
Mailing Address - City:GOLDEN
Mailing Address - State:CO
Mailing Address - Zip Code:80403-8058
Mailing Address - Country:US
Mailing Address - Phone:559-367-2336
Mailing Address - Fax:
Practice Address - Street 1:811 BRICKYARD CIR # A
Practice Address - Street 2:
Practice Address - City:GOLDEN
Practice Address - State:CO
Practice Address - Zip Code:80403-8058
Practice Address - Country:US
Practice Address - Phone:559-367-2336
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-02
Last Update Date:2019-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODEN.002035471223D0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223D0004XDental ProvidersDentistDentist Anesthesiologist