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NPI Code Detail

MEDICARE: KENIA Y MARMOL MENDOZA

MEDICARE: KENIA Y MARMOL MENDOZA
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
1390200000XStudent in an Organized Health Care Education/Training Program
21223G0001XGeneral Practice DentistryDN123911GA

General Provider Information

NPI Number : 1205625225
Entity Type Code : Individual
Provider Name (Legal Business Name) : KENIA Y MARMOL MENDOZA
Provider Business Mailing Address
First Line : 1032 BROOKFORD RD
Second Line :
City : MACON
State : GA
Zip : 31210-2307
Country : US
Telephone Number : 305-450-5432
Fax Number :
Provider Business Practice Location Address
First Line : 1536 EISENHOWER PKWY
Second Line :
City : MACON
State : GA
Zip : 31206-3130
Country : US
Telephone Number : 305-450-5432
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/05/2025
Last Update Date : 08/05/2025

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Directions to “ KENIA Y MARMOL MENDOZA ” Practice Location

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