Provider Demographics
NPI:1962820019
Name:MENDEZ HERNANDEZ, VERONICA (BSDH,RDH,EPDH)
Entity Type:Individual
Prefix:
First Name:VERONICA
Middle Name:
Last Name:MENDEZ HERNANDEZ
Suffix:
Gender:F
Credentials:BSDH,RDH,EPDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1107 NE BURNSIDE RD
Mailing Address - Street 2:
Mailing Address - City:GRESHAM
Mailing Address - State:OR
Mailing Address - Zip Code:97030-5710
Mailing Address - Country:US
Mailing Address - Phone:503-663-1404
Mailing Address - Fax:
Practice Address - Street 1:1107 NE BURNSIDE RD
Practice Address - Street 2:
Practice Address - City:GRESHAM
Practice Address - State:OR
Practice Address - Zip Code:97030-5710
Practice Address - Country:US
Practice Address - Phone:503-663-1404
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-04-04
Last Update Date:2014-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORH6598124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist