Healthcare Provider Details

I. General information

NPI: 1295066231
Provider Name (Legal Business Name): CAROLINA ELIZABETH MENDIETA DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/14/2010
Last Update Date: 01/05/2026
Certification Date: 01/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5306 VAN DYKE RD
LUTZ FL
33558-4829
US

IV. Provider business mailing address

20865 DRAKE ELM DR
LAND O LAKES FL
34638-3840
US

V. Phone/Fax

Practice location:
  • Phone: 813-797-6053
  • Fax:
Mailing address:
  • Phone: 813-503-4994
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDN29568
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: