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General NPI Number Information
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NPI Number | 1154468965
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Entity Type | Organization
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Legal Business Name | GUY W MENDIVIL DDS INC
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Dates
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Enumeration Date | 01/31/2007
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Last Update Date | 06/09/2008
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Provider Practice Location Address
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Address Line | 27725 SANTA MARGARITA PKWY SUITE 241
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City | MISSION VIEJO
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State | CA
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Zip | 92691-6704
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Country | US
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Telephone | 949-859-1318
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Fax |
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Provider Business Mailing Address
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Address Line | 27725 SANTA MARGARITA PKWY SUITE 241
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City | MISSION VIEJO
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State | CA
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Zip | 92691-6704
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Country | US
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Telephone | 949-859-1318
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. GUY W MENDIVIL
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Credential | DDS
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Telephone | 949-859-0116
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | D29737
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License Number State | CA
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