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General NPI Number Information
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NPI Number | 1437458346
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Entity Type | Individual
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Provider Name | EDGAR Y MENDIETA DDS
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Gender | Male
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Dates
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Enumeration Date | 03/17/2011
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Last Update Date | 12/20/2023
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Provider Practice Location Address
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Address Line | 3160 W BROAD ST # 2300374
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City | COLUMBUS
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State | OH
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Zip | 43204-1310
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Country | US
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Telephone | 614-279-6481
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Fax | 614-279-0199
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Provider Business Mailing Address
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Address Line | 3160 W BROAD ST
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City | COLUMBUS
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State | OH
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Zip | 43204-1310
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Country | US
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Telephone | 614-230-0374
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 022430
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 30.022430
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License Number State | OH
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