Individual
DR. JORGE MENDIETA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
CAS/MILBANK MEDICAL GROUP, 14-32 WEST 118 STREET, NEW YORK, NY 10026-1904
(212) 369-8339
Mailing address
2000 BROADWAY, #16-G, NEW YORK, NY 10023-5028
(212) 496-5090
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
043265-1
NY
Other
Enumeration date
10/25/2005
Last updated
07/08/2007
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