Individual
IVAN YANCARLO MENDOZA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
178 SUMMER ST, SOUTH WALPOLE, MA 02071-1044
(305) 766-7626
Mailing address
178 SUMMER ST, SOUTH WALPOLE, MA 02071-1044
(305) 766-7626
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
DN1858166
MA
Other
Enumeration date
11/27/2018
Last updated
11/27/2018
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