Provider Demographics
NPI:1780920421
Name:MENDEZ DENTAL INC
Entity type:Organization
Organization Name:MENDEZ DENTAL INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTONIO
Authorized Official - Middle Name:
Authorized Official - Last Name:MENDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:305-227-7997
Mailing Address - Street 1:9100 CORAL WAY
Mailing Address - Street 2:SUITE 9
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33165-2076
Mailing Address - Country:US
Mailing Address - Phone:305-227-7997
Mailing Address - Fax:305-675-3237
Practice Address - Street 1:9100 CORAL WAY
Practice Address - Street 2:SUITE 9
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33165-2076
Practice Address - Country:US
Practice Address - Phone:305-227-7997
Practice Address - Fax:305-675-3237
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-28
Last Update Date:2012-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN135201223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty