Provider Demographics
NPI:1063542421
Name:MENDOZA, ELEMER (DMD)
Entity type:Individual
Prefix:DR
First Name:ELEMER
Middle Name:
Last Name:MENDOZA
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:DR
Other - First Name:ELEMER
Other - Middle Name:
Other - Last Name:MENDOZA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DMD, PA
Mailing Address - Street 1:2327 BLACK LAKE BLVD.
Mailing Address - Street 2:
Mailing Address - City:WINTER GARDEN
Mailing Address - State:FL
Mailing Address - Zip Code:34787
Mailing Address - Country:US
Mailing Address - Phone:407-921-0340
Mailing Address - Fax:407-287-7441
Practice Address - Street 1:8810 S.W. STATE ROAD 200
Practice Address - Street 2:SUITE 101
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34481-9636
Practice Address - Country:US
Practice Address - Phone:352-854-7070
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN172621223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice