Provider Demographics
NPI:1366748725
Name:MENDEZ, MAGALY FERNANDEZ (DDS)
Entity type:Individual
Prefix:DR
First Name:MAGALY
Middle Name:FERNANDEZ
Last Name:MENDEZ
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 1:3228 GUN CLUB RD
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33406-3001
Mailing Address - Country:US
Mailing Address - Phone:561-688-4683
Mailing Address - Fax:561-688-4671
Practice Address - Street 1:3228 GUN CLUB RD
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33406-3001
Practice Address - Country:US
Practice Address - Phone:561-688-4683
Practice Address - Fax:561-688-4671
Is Sole Proprietor?:No
Enumeration Date:2011-02-02
Last Update Date:2011-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN129271223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice