Healthcare Provider Details

I. General information

NPI: 1396921300
Provider Name (Legal Business Name): MARIA DEL CARMEN MENDEZ D.M.D., M.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/21/2008
Last Update Date: 01/21/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12927 S ORANGE BLOSSOM TRL
ORLANDO FL
32837-6592
US

IV. Provider business mailing address

5015 KEENELAND CIR
ORLANDO FL
32819-3145
US

V. Phone/Fax

Practice location:
  • Phone: 407-855-6305
  • Fax:
Mailing address:
  • Phone: 407-855-6305
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License NumberDN15447
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: