Healthcare Provider Details

I. General information

NPI: 1235125899
Provider Name (Legal Business Name): HILDA M MENDEZ DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 09/20/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

576 CALLE CESAR GONZALEZ STE 307
SAN JUAN PR
00918-3756
US

IV. Provider business mailing address

576 CALLE CESAR GONZALEZ STE 307
SAN JUAN PR
00918-3756
US

V. Phone/Fax

Practice location:
  • Phone: 787-753-1405
  • Fax: 787-753-1475
Mailing address:
  • Phone: 787-753-1405
  • Fax: 787-753-1475

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number2057
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: