Carl Michael Mentesana, DDS

Primary specialty

PeriodonticsTaxonomy code 1223P0300X

License

30023 Issued in TX

Practice address

291 Renner Pkwy Ste 103
Richardson, TX 75080-1342

Phone

(214) 738-6049

NPI assigned

Jun 30, 2014

Last updated

Oct 23, 2020By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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

• Archstone Dental PLLC

  • General Practice Dentistry
  • Fort Worth, TX
  • NPI 1245479013
  NPD (past)

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

{
    "created_epoch": "1404086400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1603411200000",
    "number": "1245645175",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2403 LACY LN",
            "city": "CARROLLTON",
            "state": "TX",
            "postal_code": "750066514",
            "telephone_number": "972-869-3789"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "291 RENNER PKWY STE 103",
            "city": "RICHARDSON",
            "state": "TX",
            "postal_code": "750801342",
            "telephone_number": "214-738-6049"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MENTESANA",
        "first_name": "CARL",
        "middle_name": "MICHAEL",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-06-30",
        "last_updated": "2020-10-23",
        "certification_date": "2020-10-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "TX",
            "license": "30023",
            "primary": false
        },
        {
            "code": "1223P0300X",
            "taxonomy_group": "",
            "desc": "Dentist, Periodontics",
            "state": "TX",
            "license": "30023",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Cecelia Mendez
• Henry J Mendez, LPC
• Mendha Primary Care PLLC (A2Z Primary Care and Med Spa)
• Mae-Lin Y Mendoza, LPC
• Marie Salvante Mendoza, RPH
• Methodist Hospitals of Dallas (Methodist Richardson Medical Center)
• Methodist Hospitals of Dallas (Methodist Richardson Medical Center Pharmacy)
• Methodist Hospitals of Dallas (Methodist Richardson Medical Center Psychiatric Hospital)
• Methodist Hosptials of Dallas (Methodist Richardson Medical Center)
• Methodist Surgery Center - Richardson, LLC

• Periodontics in Richardson, TX
• Providers in Richardson, TX by specialty
• Periodontics in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 23, 2020; 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.