Provider Demographics
NPI:1215583570
Name:MENDOZA HAM, IGNACIO ESAUL (DDS)
Entity type:Individual
Prefix:MR
First Name:IGNACIO
Middle Name:ESAUL
Last Name:MENDOZA HAM
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3025 MCHENRY AVE STE N
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95350-1449
Mailing Address - Country:US
Mailing Address - Phone:209-527-3990
Mailing Address - Fax:
Practice Address - Street 1:3025 MCHENRY AVE
Practice Address - Street 2:STE N
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95350-9535
Practice Address - Country:US
Practice Address - Phone:209-527-3990
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-13
Last Update Date:2021-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1034881223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty