Healthcare Provider Details

I. General information

NPI: 1528585247
Provider Name (Legal Business Name): MICHAEL MENDELSON DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/23/2017
Last Update Date: 08/23/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4351 GARDEN CITY DR
LANDOVER MD
20785-2223
US

IV. Provider business mailing address

4611 WOODFIELD RD
BETHESDA MD
20814-4043
US

V. Phone/Fax

Practice location:
  • Phone: 301-459-3650
  • Fax:
Mailing address:
  • Phone: 301-530-6860
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223D0001X
TaxonomyPublic Health Dentistry
License Number6427
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: