Individual
KENIA Y MARMOL MENDOZA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1536 EISENHOWER PKWY, MACON, GA 31206-3130
(305) 450-5432
Mailing address
1032 BROOKFORD RD, MACON, GA 31210-2307
(305) 450-5432
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
DN123911
GA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
05/05/2025
Last updated
08/05/2025
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