Provider Demographics
NPI:1528373057
Name:MENDOZA, EDGAR E (DMD)
Entity Type:Individual
Prefix:DR
First Name:EDGAR
Middle Name:E
Last Name:MENDOZA
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1010 PLEASANT ST
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01602-1366
Mailing Address - Country:US
Mailing Address - Phone:508-755-1293
Mailing Address - Fax:
Practice Address - Street 1:1010 PLEASANT ST
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01602-1366
Practice Address - Country:US
Practice Address - Phone:508-755-1293
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-09
Last Update Date:2010-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA18102122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist