Provider Demographics
NPI:1760751721
Name:MENDOZA, HERBERT MANUEL JR (DDS)
Entity Type:Individual
Prefix:DR
First Name:HERBERT
Middle Name:MANUEL
Last Name:MENDOZA
Suffix:JR
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31843 RANCHO CALIFORNIA RD
Mailing Address - Street 2:STE 300
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92591-5120
Mailing Address - Country:US
Mailing Address - Phone:951-676-2613
Mailing Address - Fax:
Practice Address - Street 1:31843 RANCHO CALIFORNIA RD
Practice Address - Street 2:STE 300
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92591-5120
Practice Address - Country:US
Practice Address - Phone:951-676-2613
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-21
Last Update Date:2016-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA61027122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist