Active NPI
Fabian A Mendoza, DDS
- Dentist
- Albuquerque, NM
National Provider Identifier
1194455352
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- DD5630
- Practice address
- 5505 Central Ave NE
Albuquerque, NM 87108-1601 - Phone
- (505) 843-6060
- NPI assigned
- Jun 12, 2022
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | DD5630 | NM | Primary |
Addresses
Primary practice location
5505 Central Ave NE
Albuquerque, NM 87108-1601
Mailing address
15402 Oaklawn Park Dr
Houston, TX 77069-1512
Phone (832) 982-9068
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DD5630 | NM | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Family Smiles, LLC | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- General Practice Dentistry
- Albuquerque, NM
- NPI 1104118744
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1654992000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1654992000000",
"number": "1194455352",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "15402 OAKLAWN PARK DR",
"city": "HOUSTON",
"state": "TX",
"postal_code": "770691512",
"telephone_number": "832-982-9068"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5505 CENTRAL AVE NE",
"city": "ALBUQUERQUE",
"state": "NM",
"postal_code": "871081601",
"telephone_number": "505-843-6060"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MENDOZA",
"first_name": "FABIAN",
"middle_name": "A",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2022-06-12",
"last_updated": "2022-06-12",
"certification_date": "2022-06-07",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "NM",
"license": "DD5630",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Albuquerque, NM
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 12, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.