MEDICARE: DR. EDGAR E MENDOZA D.M.D.

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	18102	MA

General Provider Information

NPI Number	:	1528373057
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. EDGAR E MENDOZA D.M.D.

Provider Business Mailing Address
First Line	:	1010 PLEASANT ST
Second Line	:
City	:	WORCESTER
State	:	MA
Zip	:	01602-1366
Country	:	US
Telephone Number	:	508-755-1293
Fax Number	:

Provider Business Practice Location Address
First Line	:	1010 PLEASANT ST
Second Line	:
City	:	WORCESTER
State	:	MA
Zip	:	01602-1366
Country	:	US
Telephone Number	:	508-755-1293
Fax Number	:

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

Provider Enumeration Date	:	08/09/2010
Last Update Date	:	08/09/2010

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