MEDICARE: WENDY P BONILLA 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
1	124Q00000X	Dental Hygienist	9215	MD

General Provider Information

NPI Number	:	1760361836
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WENDY P BONILLA MENDOZA

Provider Business Mailing Address
First Line	:	8436 MOUNTAIN LAUREL LN
Second Line	:
City	:	GAITHERSBURG
State	:	MD
Zip	:	20879-1555
Country	:	US
Telephone Number	:	240-755-3145
Fax Number	:

Provider Business Practice Location Address
First Line	:	806 W DIAMOND AVE STE 330
Second Line	:
City	:	GAITHERSBURG
State	:	MD
Zip	:	20878-1470
Country	:	US
Telephone Number	:	301-838-9300
Fax Number	:

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

Provider Enumeration Date	:	09/01/2025
Last Update Date	:	09/01/2025

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