Provider Demographics
NPI:1962179390
Name:OLGA A MENDEZ DDS AND ASSOCIATES
Entity type:Organization
Organization Name:OLGA A MENDEZ DDS AND ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, MAIN PROVIDER
Authorized Official - Prefix:DR
Authorized Official - First Name:OLGA
Authorized Official - Middle Name:ADRIANE
Authorized Official - Last Name:MENDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:708-317-5880
Mailing Address - Street 1:6844 CERMAK RD
Mailing Address - Street 2:
Mailing Address - City:BERWYN
Mailing Address - State:IL
Mailing Address - Zip Code:60402-2240
Mailing Address - Country:US
Mailing Address - Phone:708-317-5880
Mailing Address - Fax:708-317-5315
Practice Address - Street 1:6844 CERMAK RD
Practice Address - Street 2:
Practice Address - City:BERWYN
Practice Address - State:IL
Practice Address - Zip Code:60402-2240
Practice Address - Country:US
Practice Address - Phone:708-317-5880
Practice Address - Fax:708-317-5315
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-24
Last Update Date:2021-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty