Gustavo Alberto Mendez

Primary specialty

DentistTaxonomy code 122300000X

License

42651 Issued in TX

Practice address

8942 S Broadway Ave Ste 128
Tyler, TX 75703-5443

Phone

(903) 594-4562

NPI assigned

Apr 13, 2023

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• South Tyler Family Dentistry PLLC

  dba Fresh Dental and Orthodontics

  • Dentist
  • Tyler, TX
  • NPI 1548636061
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1681344000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1783123200000",
    "number": "1093401887",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3302 GASTON AVE",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752462013",
            "telephone_number": "214-828-8215"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8942 S BROADWAY AVE STE 128",
            "city": "TYLER",
            "state": "TX",
            "postal_code": "757035443",
            "telephone_number": "903-594-4562"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3873 Hwy 64 W",
            "address_purpose": "LOCATION",
            "city": "Tyler",
            "state": "TX",
            "postal_code": "757046925",
            "country_code": "US",
            "telephone_number": "903-593-4867",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "3052 N Eastman Rd Ste 108",
            "address_purpose": "LOCATION",
            "city": "Longview",
            "state": "TX",
            "postal_code": "756055013",
            "country_code": "US",
            "telephone_number": "903-663-6900",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MENDEZ",
        "first_name": "GUSTAVO",
        "middle_name": "ALBERTO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2023-04-13",
        "last_updated": "2026-07-04",
        "certification_date": "2026-07-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "TX",
            "license": "42651",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Melrose HCC, LLC (Melrose Nursing & Rehab)
• Ashley Melton
• Ellen Gwendolyn Melton, MD
• James R Menard, MD
• Melinda C Menard, MD
• Christofferson Villareal Mendoza, PT, DPT
• Lizbeth Mendoza
• Mary Grace Salanga Mendoza, PTA
• Melinda Mendoza, LCSW
• Mentis Management Services, LLC

• Dentist in Tyler, TX
• Providers in Tyler, TX by specialty
• Dentist in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 4, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.