=====================================================
General NPI Number Information
=====================================================
NPI Number | 1922313477
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | EDGAR E MENDOZA AND PATRICIA A SLININ DMD PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/09/2010
-----------------------------------------------------
Last Update Date | 01/19/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 70 ELM ST SUITE 1
-----------------------------------------------------
City | WORCESTER
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 01609-2300
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 508-755-1293
-----------------------------------------------------
Fax | 508-798-5256
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 70 ELM ST SUITE 1
-----------------------------------------------------
City | WORCESTER
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 01609-2300
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 508-755-1293
-----------------------------------------------------
Fax | 508-798-5256
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. EDGAR E MENDZA
-----------------------------------------------------
Credential | D.M.D
-----------------------------------------------------
Telephone | 508-755-1293
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------