Healthcare Provider Details

I. General information

NPI: 1275507774
Provider Name (Legal Business Name): RAFAEL A MENDEZ DMD.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/14/2006
Last Update Date: 05/28/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2140 W ARLINGTON BLVD
GREENVILLE NC
27834-5709
US

IV. Provider business mailing address

PO BOX 8713
GREENVILLE NC
27835-8713
US

V. Phone/Fax

Practice location:
  • Phone: 252-355-5252
  • Fax:
Mailing address:
  • Phone: 787-242-2842
  • Fax: 787-242-2842

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number2619
License Number StatePR
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number9469
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number056541
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: