Provider Demographics
NPI:1518748755
Name:JOSE MENDOZA PROFESSIONAL SERVICES
Entity Type:Organization
Organization Name:JOSE MENDOZA PROFESSIONAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:ANTONIO
Authorized Official - Last Name:MENDOZA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:509-205-0655
Mailing Address - Street 1:8921 SANDIFUR PKWY STE 102
Mailing Address - Street 2:
Mailing Address - City:PASCO
Mailing Address - State:WA
Mailing Address - Zip Code:99301-9596
Mailing Address - Country:US
Mailing Address - Phone:509-302-2663
Mailing Address - Fax:509-302-2462
Practice Address - Street 1:8921 SANDIFUR PKWY STE 102
Practice Address - Street 2:
Practice Address - City:PASCO
Practice Address - State:WA
Practice Address - Zip Code:99301-9596
Practice Address - Country:US
Practice Address - Phone:509-302-2663
Practice Address - Fax:509-302-2462
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-12
Last Update Date:2023-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental