Provider Demographics
NPI:1740456664
Name:MENDES, GERALD WAYNE JR (DDS)
Entity type:Individual
Prefix:DR
First Name:GERALD
Middle Name:WAYNE
Last Name:MENDES
Suffix:JR
Gender:M
Credentials:DDS
Other - Prefix:
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Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 7223
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94537-7223
Mailing Address - Country:US
Mailing Address - Phone:510-794-8255
Mailing Address - Fax:510-794-8371
Practice Address - Street 1:1895 MOWRY AVE
Practice Address - Street 2:SUITE 119
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94538-1737
Practice Address - Country:US
Practice Address - Phone:510-794-8255
Practice Address - Fax:510-794-8371
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-30
Last Update Date:2008-04-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA318331223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice