Organization
GUY W MENDIVIL, D.D.S. PROFESSIONAL DENTAL CORPORATION
Active
Other names
Tri-City Orthodontics
Organization subpart
No
Provider details
NPI number
Authorized official
MR. GUY W MENDIVIL DDS (OWNER)
(760) 945-4692
Entity
Organization
Contact information
Practice address
3998 VISTA WAY SUITE B, OCEANSIDE, CA 92056
(760) 945-1420
(760) 945-4692
Mailing address
3998 VISTA WAY SUITE B, OCEANSIDE, CA 92056
(760) 945-1420
(760) 945-4692
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
D29737
CA
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
—
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
G93914-02
MEDI-CAL/DENTI-CAL
CA
01
—
G9391402
DENTI-CAL PROVIDER
CA
Enumeration date
05/14/2008
Last updated
07/01/2015
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