Provider Demographics
NPI:1790887297
Name:MENDENHALL, RONALD EUGENE (DDS)
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:EUGENE
Last Name:MENDENHALL
Suffix:
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 1:101 W MULLAN AVE
Mailing Address - Street 2:
Mailing Address - City:POST FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83854-9217
Mailing Address - Country:US
Mailing Address - Phone:208-773-4185
Mailing Address - Fax:208-777-0341
Practice Address - Street 1:101 W MULLAN AVE
Practice Address - Street 2:
Practice Address - City:POST FALLS
Practice Address - State:ID
Practice Address - Zip Code:83854-9217
Practice Address - Country:US
Practice Address - Phone:208-773-4185
Practice Address - Fax:208-777-0341
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-04
Last Update Date:2007-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDD-37721223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice