Provider Demographics
NPI:1427518174
Name:MENDEZ, INGRID (RDH)
Entity type:Individual
Prefix:MS
First Name:INGRID
Middle Name:
Last Name:MENDEZ
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 CHURCH ST APT 8
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94114-1331
Mailing Address - Country:US
Mailing Address - Phone:415-517-2958
Mailing Address - Fax:
Practice Address - Street 1:210 CHURCH ST APT 8
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94114-1331
Practice Address - Country:US
Practice Address - Phone:415-517-2958
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-20
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA24141124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist