Provider Demographics
NPI:1952719395
Name:MENDOZA, TANYA VALERIE (RDH)
Entity Type:Individual
Prefix:MS
First Name:TANYA
Middle Name:VALERIE
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 1:26901 N 90TH AVE
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85383-3795
Mailing Address - Country:US
Mailing Address - Phone:623-451-5189
Mailing Address - Fax:
Practice Address - Street 1:3140 W BUCKEYE RD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85009-5637
Practice Address - Country:US
Practice Address - Phone:623-451-5189
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-29
Last Update Date:2014-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZH05261124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist