Provider Demographics
NPI:1831303783
Name:MENENDEZ, ANTHONY RICHARD (DDS, MAGD)
Entity Type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:RICHARD
Last Name:MENENDEZ
Suffix:
Gender:M
Credentials:DDS, MAGD
Other - Prefix:DR
Other - First Name:TONY
Other - Middle Name:
Other - Last Name:MENENDEZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS, MAGD
Mailing Address - Street 1:4120 TAMIAMI TRL
Mailing Address - Street 2:SUITE A
Mailing Address - City:PORT CHARLOTTE
Mailing Address - State:FL
Mailing Address - Zip Code:33952-9200
Mailing Address - Country:US
Mailing Address - Phone:941-624-4575
Mailing Address - Fax:
Practice Address - Street 1:4120 TAMIAMI TRAIL SUITE A
Practice Address - Street 2:SUITE A
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33952-9200
Practice Address - Country:US
Practice Address - Phone:941-624-4575
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-10
Last Update Date:2019-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL10575122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist