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General NPI Number Information
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NPI Number | 1518221092
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Entity Type | Organization
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Legal Business Name | JAMES H. MENDILLO, DMD
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Dates
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Enumeration Date | 06/28/2012
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Last Update Date | 06/28/2012
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Provider Practice Location Address
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Address Line | 62 KIRKHAM ST
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City | BRANFORD
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State | CT
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Zip | 06405-3504
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Country | US
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Telephone | 203-488-6314
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Fax | 203-488-3080
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Provider Business Mailing Address
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Address Line | 62 KIRKHAM ST
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City | BRANFORD
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State | CT
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Zip | 06405-3504
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Country | US
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Telephone | 203-488-6314
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Fax | 203-488-3080
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Authorized Official
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Title or Position | OWNER
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Name | JAMES H MENDILLO
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Credential | DMD
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Telephone | 203-488-6314
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 486500
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License Number State | CT
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