Provider Demographics
NPI:1457107203
Name:MENDEZ, JOSE R (DMD)
Entity Type:Individual
Prefix:DR
First Name:JOSE
Middle Name:R
Last Name:MENDEZ
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:DR
Other - First Name:JOSE
Other - Middle Name:R
Other - Last Name:MENDEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD
Mailing Address - Street 1:100 CARR 6690 APT 1002
Mailing Address - Street 2:
Mailing Address - City:VEGA ALTA
Mailing Address - State:PR
Mailing Address - Zip Code:00692-8732
Mailing Address - Country:US
Mailing Address - Phone:787-356-3787
Mailing Address - Fax:
Practice Address - Street 1:333 CALLE 25 NE
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00920-2531
Practice Address - Country:US
Practice Address - Phone:787-356-3787
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-24
Last Update Date:2024-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR003495122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist