Healthcare Provider Details

I. General information

NPI: 1578312369
Provider Name (Legal Business Name): CARLOS MOISES MENDEZ CASTELLANOS DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/15/2024
Last Update Date: 09/25/2026
Certification Date: 09/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6442 NW 186TH ST
HIALEAH FL
33015-6006
US

IV. Provider business mailing address

1133 W 41ST PL
HIALEAH FL
33012-4177
US

V. Phone/Fax

Practice location:
  • Phone: 786-593-3556
  • Fax:
Mailing address:
  • Phone: 786-593-3556
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDN32303
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: