Provider Demographics
NPI:1982926341
Name:MENDOZA, MILAGROS OTILIA (DMD)
Entity Type:Individual
Prefix:DR
First Name:MILAGROS
Middle Name:OTILIA
Last Name:MENDOZA
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:888 BISCAYNE BLVD APT 2702
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33132-1553
Mailing Address - Country:US
Mailing Address - Phone:305-401-3677
Mailing Address - Fax:
Practice Address - Street 1:5511 SW 8TH ST STE 201
Practice Address - Street 2:
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33134-2272
Practice Address - Country:US
Practice Address - Phone:305-264-1200
Practice Address - Fax:786-476-5508
Is Sole Proprietor?:No
Enumeration Date:2010-02-25
Last Update Date:2013-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN189171223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice