Provider Demographics
NPI:1912636515
Name:MENDEZ, MAYLEN (DDS)
Entity type:Individual
Prefix:
First Name:MAYLEN
Middle Name:
Last Name:MENDEZ
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6235 PECAN TREE
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78240-1867
Mailing Address - Country:US
Mailing Address - Phone:786-553-2724
Mailing Address - Fax:
Practice Address - Street 1:12311 NACOGDOCHES RD STE 107
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78217-2139
Practice Address - Country:US
Practice Address - Phone:210-742-7248
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-08
Last Update Date:2022-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX38445122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist