Individual
DR. CARL MICHAEL MENTESANA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
291 RENNER PKWY STE 103, RICHARDSON, TX 75080-1342
(214) 738-6049
Mailing address
2403 LACY LN, CARROLLTON, TX 75006-6514
(972) 869-3789
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
30023
TX
1223P0300X
Periodontics
Primary
30023
TX
Other
Enumeration date
06/30/2014
Last updated
10/23/2020
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