Organization
CARLENE A MENDIETA DDS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. CARLENE A MENDIETA DDS (OWNER)
(510) 724-8441
Entity
Organization
Contact information
Practice address
1420 TARA HILLS DR, #C, PINOLE, CA 94564-2530
(510) 724-8441
(510) 724-0120
Mailing address
1420 TARA HILLS DR, #C, PINOLE, CA 94564-2530
(510) 724-8441
(510) 724-0120
Taxonomy
Speciality
Code
Description
License number
State
1223P0300X
Periodontics
Primary
DA34741
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
DA34741
LICENSE NUMBER
CA
Enumeration date
11/30/2005
Last updated
07/14/2008
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