Provider Demographics
NPI:1194341776
Name:MENDOZA, CHRISTIAN JESUS (DMD)
Entity type:Individual
Prefix:DR
First Name:CHRISTIAN
Middle Name:JESUS
Last Name:MENDOZA
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1501 ISLAND AVE APT 435
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92101-7965
Mailing Address - Country:US
Mailing Address - Phone:619-840-5115
Mailing Address - Fax:
Practice Address - Street 1:35952 WINCHESTER RD BLDG 2
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:CA
Practice Address - Zip Code:92596-7537
Practice Address - Country:US
Practice Address - Phone:888-329-8111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-19
Last Update Date:2022-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZPD0011122300000X
CA107354122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist