Provider Demographics
NPI:1982822359
Name:MENDOZA, ERNESTO J (DDS)
Entity Type:Individual
Prefix:DR
First Name:ERNESTO
Middle Name:J
Last Name:MENDOZA
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 1:11020 SW 88TH ST STE 202
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33176-1202
Mailing Address - Country:US
Mailing Address - Phone:305-279-0408
Mailing Address - Fax:305-271-2447
Practice Address - Street 1:11020 SW 88TH ST STE 202
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33176-1202
Practice Address - Country:US
Practice Address - Phone:305-279-0408
Practice Address - Fax:305-271-2447
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN11544122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL581518OtherUNITED CONCORDIA
FL63021OtherBC & BS OF FLORIDA