Provider Demographics
NPI:1255971297
Name:MENDILLO FAMILY DENTISTRY PLLC
Entity type:Organization
Organization Name:MENDILLO FAMILY DENTISTRY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HILLARY
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:MENDILLO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:203-488-6314
Mailing Address - Street 1:62 KIRKHAM ST
Mailing Address - Street 2:
Mailing Address - City:BRANFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06405-3504
Mailing Address - Country:US
Mailing Address - Phone:203-488-6314
Mailing Address - Fax:
Practice Address - Street 1:62 KIRKHAM ST
Practice Address - Street 2:
Practice Address - City:BRANFORD
Practice Address - State:CT
Practice Address - Zip Code:06405-3504
Practice Address - Country:US
Practice Address - Phone:203-488-6314
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-07
Last Update Date:2020-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1356479273OtherNPPES
1144584954OtherNPPES