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General NPI Number Information
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NPI Number | 1780668020
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Entity Type | Organization
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Legal Business Name | CARLENE A MENDIETA DDS
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Dates
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Enumeration Date | 11/30/2005
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Last Update Date | 07/14/2008
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Provider Practice Location Address
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Address Line | 1420 TARA HILLS DR #C
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City | PINOLE
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State | CA
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Zip | 94564-2530
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Country | US
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Telephone | 510-724-8441
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Fax | 510-724-0120
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Provider Business Mailing Address
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Address Line | 1420 TARA HILLS DR #C
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City | PINOLE
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State | CA
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Zip | 94564-2530
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Country | US
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Telephone | 510-724-8441
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Fax | 510-724-0120
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Authorized Official
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Title or Position | OWNER
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Name | MS. CARLENE A MENDIETA
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Credential | DDS
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Telephone | 510-724-8441
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number | DA34741
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License Number State | CA
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