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DR. LOUIE BANTUGAN MENDOZA D.D.S.

>> Dentist >> Dental Providers

Registrant NPI Number: 1104023621

Individual Registrant:
DR. LOUIE BANTUGAN MENDOZA D.D.S.
Gender: M
Sole Proprietor

Location and contact information for practice:
296 ARLINGTON AVE  KENSINGTON, CA 94707-1402 US
Tel: 510-526-8311  Fax: 510-526-9323

Contact information for business:
296 ARLINGTON AVE  KENSINGTON, CA 94707-1402 US
Tel: 510-526-8311  Fax: 510-526-9323

Registration Information:
NPI: 1104023621
Entity Type: Individual

Specialty information:

PrimaryCodeCategory/DescriptionStateLicense Number
Y122300000XDental Providers
Dentist
CA42937

Legacy codes, insurance codes and state license numbers:

IssuerNumberStateType
TAX ID943307533CA01




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