Provider Demographics
NPI:1518221092
Name:JAMES H. MENDILLO, DMD
Entity Type:Organization
Organization Name:JAMES H. MENDILLO, DMD
Other - Org Name:MENDILLO FAMILY DENTISTRY
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:H
Authorized Official - Last Name:MENDILLO
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:203-488-6314
Mailing Address - Street 1:62 KIRKHAM ST
Mailing Address - Street 2:
Mailing Address - City:BRANFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06405-3504
Mailing Address - Country:US
Mailing Address - Phone:203-488-6314
Mailing Address - Fax:203-488-3080
Practice Address - Street 1:62 KIRKHAM ST
Practice Address - Street 2:
Practice Address - City:BRANFORD
Practice Address - State:CT
Practice Address - Zip Code:06405-3504
Practice Address - Country:US
Practice Address - Phone:203-488-6314
Practice Address - Fax:203-488-3080
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-28
Last Update Date:2012-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT4865001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty