Provider Demographics
NPI:1669875944
Name:JCARLOS MENDOZA, D.D.S., A PROFESSIONAL DENTAL CORPORATION
Entity type:Organization
Organization Name:JCARLOS MENDOZA, D.D.S., A PROFESSIONAL DENTAL CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JUANCARLOS
Authorized Official - Middle Name:PARTIDA
Authorized Official - Last Name:MENDOZA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:559-298-3200
Mailing Address - Street 1:7035 N CHESTNUT AVE
Mailing Address - Street 2:SUITE #107
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720-0352
Mailing Address - Country:US
Mailing Address - Phone:559-298-3200
Mailing Address - Fax:
Practice Address - Street 1:7035 N CHESTNUT AVE
Practice Address - Street 2:SUITE #107
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720-0352
Practice Address - Country:US
Practice Address - Phone:559-298-3200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-01
Last Update Date:2014-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA583841223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty