Provider Demographics
NPI:1235280777
Name:MENDOZA, ANNA MARIE (DDS)
Entity type:Individual
Prefix:DR
First Name:ANNA
Middle Name:MARIE
Last Name:MENDOZA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3041 BONITA RD STE 101
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91910-3265
Mailing Address - Country:US
Mailing Address - Phone:619-591-9222
Mailing Address - Fax:619-591-9217
Practice Address - Street 1:3041 BONITA RD STE 101
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91910-3265
Practice Address - Country:US
Practice Address - Phone:619-591-9222
Practice Address - Fax:619-591-9217
Is Sole Proprietor?:No
Enumeration Date:2007-01-12
Last Update Date:2019-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA541781223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice