Healthcare Provider Details

I. General information

NPI: 1740117191
Provider Name (Legal Business Name): DANIEL MENDEZ
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/07/2026
Last Update Date: 06/05/2026
Certification Date: 06/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13733 N PRASADA PKWY STE 108
SURPRISE AZ
85388-8014
US

IV. Provider business mailing address

19822 N 47TH DR
GLENDALE AZ
85308-5128
US

V. Phone/Fax

Practice location:
  • Phone: 623-777-3329
  • Fax:
Mailing address:
  • Phone: 818-826-0524
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberD012840
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: