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General NPI Number Information
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NPI Number | 1255477592
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Entity Type | Organization
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Legal Business Name | GUY W MENDIVIL DDS PROFESSIONAL DENTAL CORP
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Dates
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Enumeration Date | 01/30/2007
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Last Update Date | 06/22/2015
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Provider Practice Location Address
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Address Line | 515 W COLUMBUS ST STE AB
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City | BAKERSFIELD
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State | CA
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Zip | 93301-5846
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Country | US
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Telephone | 661-323-5910
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Fax |
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Provider Business Mailing Address
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Address Line | 515 W COLUMBUS ST STE AB
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City | BAKERSFIELD
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State | CA
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Zip | 93301-5846
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Country | US
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Telephone | 661-323-5910
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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 | 661-323-5910
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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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