Organization
MENDIETA, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. EDGAR YAHIR MENDIETA DDS (ORTHODONTIST)
(310) 592-2057
Entity
Organization
Contact information
Practice address
3079 W BROAD ST STE 6, COLUMBUS, OH 43204-1397
(614) 279-6481
Mailing address
3079 W BROAD ST STE 6, COLUMBUS, OH 43204-1397
(614) 279-6481
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
30.022430
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3147286
—
OH
Enumeration date
06/10/2011
Last updated
06/10/2011
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