Provider Demographics
NPI:1356664361
Name:MENDOZA, JULIO (DDS)
Entity type:Individual
Prefix:
First Name:JULIO
Middle Name:
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 1:1494 BALHAN DR
Mailing Address - Street 2:SUITE B
Mailing Address - City:CONCORD
Mailing Address - State:CA
Mailing Address - Zip Code:94521-3740
Mailing Address - Country:US
Mailing Address - Phone:925-682-2002
Mailing Address - Fax:
Practice Address - Street 1:1494 BALHAN DR
Practice Address - Street 2:SUITE B
Practice Address - City:CONCORD
Practice Address - State:CA
Practice Address - Zip Code:94521-3740
Practice Address - Country:US
Practice Address - Phone:925-682-2002
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-04
Last Update Date:2010-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA36677122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist