Provider Demographics
NPI:1255562906
Name:MENDOZA, ANDRES M (DDS)
Entity type:Individual
Prefix:DR
First Name:ANDRES
Middle Name:M
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 1:3630 STANLEY RD
Mailing Address - Street 2:
Mailing Address - City:FORT SAM HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:78234-7697
Mailing Address - Country:US
Mailing Address - Phone:210-279-8022
Mailing Address - Fax:210-221-0824
Practice Address - Street 1:3698 CHAMBERS PASS
Practice Address - Street 2:
Practice Address - City:JBSA FORT SAM HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:78234-7697
Practice Address - Country:US
Practice Address - Phone:210-279-8022
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-29
Last Update Date:2023-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX24749122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist