MEDICARE: DR. RACHEL LYNN MENDAZONA 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	D011571	AZ
2	122300000X	Dentist	D11708	OR

General Provider Information

NPI Number	:	1942925318
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RACHEL LYNN MENDAZONA DMD

Provider Business Mailing Address
First Line	:	16204 SW VAQUEROS WAY
Second Line	:
City	:	POWELL BUTTE
State	:	OR
Zip	:	97753-0411
Country	:	US
Telephone Number	:	541-325-6339
Fax Number	:

Provider Business Practice Location Address
First Line	:	21001 N TATUM BLVD STE 80-1690
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85050-5233
Country	:	US
Telephone Number	:	480-419-9200
Fax Number	:

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

Provider Enumeration Date	:	10/07/2022
Last Update Date	:	11/13/2023

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