MEDICARE: MARLENE MENDEZ DMD

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	122300000X	Dentist	18004	FL
2	122300000X	Dentist	4406	SC

General Provider Information

NPI Number	:	1336337047
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARLENE MENDEZ DMD

Provider Business Mailing Address
First Line	:	PO BOX 547
Second Line	:
City	:	LITTLE RIVER
State	:	SC
Zip	:	29566-0547
Country	:	US
Telephone Number	:	843-663-1033
Fax Number	:	843-663-1018

Provider Business Practice Location Address
First Line	:	1240 HIGHWAY 17 SOUTH
Second Line	:
City	:	NORTH MYRTLE BEACH
State	:	SC
Zip	:	29582-3707
Country	:	US
Telephone Number	:	843-663-1033
Fax Number	:	843-663-3303

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

Provider Enumeration Date	:	10/09/2007
Last Update Date	:	09/25/2009

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Directions to “ MARLENE MENDEZ DMD” Practice Location

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