Provider Demographics
NPI:1205433547
Name:MENDENHALL, TERYN (DMD)
Entity type:Individual
Prefix:DR
First Name:TERYN
Middle Name:
Last Name:MENDENHALL
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3431 RIDGE MEADOW ST
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89135-7827
Mailing Address - Country:US
Mailing Address - Phone:702-354-1010
Mailing Address - Fax:
Practice Address - Street 1:8275 S EASTERN AVE STE 101
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89123-2543
Practice Address - Country:US
Practice Address - Phone:702-967-1799
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-08
Last Update Date:2020-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT7596733-99211223G0001X
NV74011223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice