Provider Demographics
NPI:1023671906
Name:MENDEZ-CEBALLOS, MILCA (DDS)
Entity type:Individual
Prefix:DR
First Name:MILCA
Middle Name:
Last Name:MENDEZ-CEBALLOS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2230 RIDGEWOOD RD STE 101
Mailing Address - Street 2:
Mailing Address - City:WYOMISSING
Mailing Address - State:PA
Mailing Address - Zip Code:19610-3600
Mailing Address - Country:US
Mailing Address - Phone:215-427-5127
Mailing Address - Fax:
Practice Address - Street 1:193 LARKSPUR LN
Practice Address - Street 2:
Practice Address - City:EPHRATA
Practice Address - State:PA
Practice Address - Zip Code:17522-8402
Practice Address - Country:US
Practice Address - Phone:215-427-5127
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-17
Last Update Date:2025-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0424761223P0221X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Yes1223P0221XDental ProvidersDentistPediatric Dentistry