Provider Demographics
NPI:1881086452
Name:MENDOZA, MERCEDES (RDH)
Entity type:Individual
Prefix:
First Name:MERCEDES
Middle Name:
Last Name:MENDOZA
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7615 UMBRA HTS
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78252-2256
Mailing Address - Country:US
Mailing Address - Phone:210-394-7164
Mailing Address - Fax:
Practice Address - Street 1:7615 UMBRA HTS
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78252-2256
Practice Address - Country:US
Practice Address - Phone:210-394-7164
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-02-19
Last Update Date:2015-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX18918124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist