MEDICARE: DR. HOWARD A MENDELSOHN D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	0401003992	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	035759	OTHER	VA	ANTHEM BCBS

General Provider Information

NPI Number	:	1154337145
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. HOWARD A MENDELSOHN D.D.S.

Provider Business Mailing Address
First Line	:	6095 INDIAN RIVER RD
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23464-3818
Country	:	US
Telephone Number	:	757-424-1976
Fax Number	:	757-424-3152

Provider Business Practice Location Address
First Line	:	6095 INDIAN RIVER RD
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23464-3818
Country	:	US
Telephone Number	:	757-424-1976
Fax Number	:	757-424-3152

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/31/2006
Last Update Date	:	07/08/2007

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