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DR. LOUIE BANTUGAN MENDOZA D.D.S.
>> Dentist >> Dental ProvidersRegistrant NPI Number: 1104023621
Individual Registrant:DR. LOUIE BANTUGAN MENDOZA D.D.S.
Gender: M
Sole Proprietor
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
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
Tel: 510-526-8311 Fax: 510-526-9323
Registration Information:
NPI: 1104023621
Entity Type: Individual
Entity Type: Individual
Specialty information:
| Primary | Code | Category/Description | State | License Number |
|---|---|---|---|---|
| Y | 122300000X | Dental Providers Dentist | CA | 42937 |
Legacy codes, insurance codes and state license numbers:
| Issuer | Number | State | Type |
|---|---|---|---|
| TAX ID | 943307533 | CA | 01 |
