Provider Demographics
NPI:1568525582
Name:MENDOZA, RICARDO Y (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:RICARDO
Middle Name:Y
Last Name:MENDOZA
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3021 W ARMITAGE AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60647-6569
Mailing Address - Country:US
Mailing Address - Phone:773-772-2545
Mailing Address - Fax:773-772-2555
Practice Address - Street 1:3021 W ARMITAGE AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60647-6569
Practice Address - Country:US
Practice Address - Phone:773-772-2545
Practice Address - Fax:773-772-2555
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-19
Last Update Date:2012-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019-0255661223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry