Provider Demographics
NPI:1659570430
Name:MENDEZ, ANTONIO (DMD)
Entity Type:Individual
Prefix:
First Name:ANTONIO
Middle Name:
Last Name:MENDEZ
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 1:2106 W 68TH ST
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33016-1804
Mailing Address - Country:US
Mailing Address - Phone:305-827-6661
Mailing Address - Fax:305-827-9977
Practice Address - Street 1:2106 W 68TH ST
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33016-1804
Practice Address - Country:US
Practice Address - Phone:305-827-6661
Practice Address - Fax:305-827-9977
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-12
Last Update Date:2007-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL135201223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice