Individual
DR. EDGAR Y MENDIETA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
3160 W BROAD ST # 2300374, COLUMBUS, OH 43204-1310
(614) 279-6481
(614) 279-0199
Mailing address
3160 W BROAD ST, COLUMBUS, OH 43204-1310
(614) 230-0374
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
022430
OH
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
30.022430
OH
Other
Enumeration date
03/17/2011
Last updated
12/20/2023
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