Provider Demographics
NPI:1790417988
Name:LA NUEZ MENDEZ, HENRRY LAZARO (DMD)
Entity Type:Individual
Prefix:DR
First Name:HENRRY
Middle Name:LAZARO
Last Name:LA NUEZ 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 1:16825 SW 109TH PL
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33157-9029
Mailing Address - Country:US
Mailing Address - Phone:786-552-2108
Mailing Address - Fax:
Practice Address - Street 1:16825 SW 109TH PL
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33157-9029
Practice Address - Country:US
Practice Address - Phone:786-552-2108
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-27
Last Update Date:2022-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL269871223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice