Provider Demographics
NPI:1659772408
Name:TRISTAN MENDOZA DDS INC
Entity Type:Organization
Organization Name:TRISTAN MENDOZA DDS INC
Other - Org Name:HEALING HANDS DENTAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TRISTAN
Authorized Official - Middle Name:E
Authorized Official - Last Name:MENDOZA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:925-825-1081
Mailing Address - Street 1:1849 WILLOW PASS RD
Mailing Address - Street 2:SUITE 400
Mailing Address - City:CONCORD
Mailing Address - State:CA
Mailing Address - Zip Code:94520-2524
Mailing Address - Country:US
Mailing Address - Phone:925-825-1081
Mailing Address - Fax:925-825-1094
Practice Address - Street 1:1849 WILLOW PASS RD
Practice Address - Street 2:SUITE 400
Practice Address - City:CONCORD
Practice Address - State:CA
Practice Address - Zip Code:94520-2524
Practice Address - Country:US
Practice Address - Phone:925-825-1081
Practice Address - Fax:925-825-1094
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-11
Last Update Date:2014-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA597361223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty