Mark Mendiola, D.D.S., P.C.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

019.026772 Issued in IL

Legal business name

MARK MENDIOLA, D.D.S., P.C.

Practice address

5050 S Kedzie Ave
Unit a
Chicago, IL 60632-3009

Phone

(773) 778-2200

NPI assigned

Dec 17, 2010

Organization subpart

No

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

Authorized official

Name

Dr. Mark Mendiola, D.D.S.

Title

Dentist/Owner

Phone

(248) 210-8049

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1292544000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1292544000000",
    "number": "1508169251",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "345 N LASALLE ST",
            "address_2": "UNIT 4407",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606546101",
            "telephone_number": "248-210-8049"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5050 S KEDZIE AVE",
            "address_2": "UNIT A",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606323009",
            "telephone_number": "773-778-2200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARK MENDIOLA, D.D.S., P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-12-17",
        "last_updated": "2010-12-17",
        "status": "A",
        "authorized_official_last_name": "MENDIOLA",
        "authorized_official_first_name": "MARK",
        "authorized_official_title_or_position": "DENTIST/OWNER",
        "authorized_official_telephone_number": "248-210-8049",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.D.S."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "IL",
            "license": "019.026772",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• General Practice Dentistry in Chicago, IL
• Providers in Chicago, IL by specialty
• General Practice Dentistry in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 17, 2010; 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.