Provider Demographics
NPI:1881897262
Name:MENDEZ, OMAR ANTHONY (DDS)
Entity type:Individual
Prefix:DR
First Name:OMAR
Middle Name:ANTHONY
Last Name:MENDEZ
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7320 N MOPAC
Mailing Address - Street 2:#200
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78731
Mailing Address - Country:US
Mailing Address - Phone:512-345-5885
Mailing Address - Fax:512-345-5647
Practice Address - Street 1:7320 N MOPAC
Practice Address - Street 2:#200
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78731
Practice Address - Country:US
Practice Address - Phone:512-345-5885
Practice Address - Fax:512-345-5647
Is Sole Proprietor?:No
Enumeration Date:2007-06-06
Last Update Date:2022-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI22983122300000X
TX218051223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist