MEDICARE: DR. ANDRES M MENDOZA DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	24749	TX

General Provider Information

NPI Number	:	1255562906
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANDRES M MENDOZA DDS

Provider Business Mailing Address
First Line	:	3630 STANLEY RD
Second Line	:
City	:	FORT SAM HOUSTON
State	:	TX
Zip	:	78234-7697
Country	:	US
Telephone Number	:	210-279-8022
Fax Number	:	210-221-0824

Provider Business Practice Location Address
First Line	:	3698 CHAMBERS PASS
Second Line	:
City	:	JBSA FORT SAM HOUSTON
State	:	TX
Zip	:	78234-7697
Country	:	US
Telephone Number	:	210-279-8022
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/29/2009
Last Update Date	:	06/26/2023

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