Luis Andre Mendonca Mezzomo, DR.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

136000272 Issued in IL

Practice address

801 S Paulina St
Chicago, IL 60612-7210

Phone

(312) 342-6140

NPI assigned

Feb 14, 2024

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

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

{
    "created_epoch": "1707868800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1708041600000",
    "number": "1639934243",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "939 W WASHINGTON BLVD APT W709",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606072263",
            "telephone_number": "312-342-6140"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "801 S PAULINA ST",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606127210",
            "telephone_number": "312-342-6140"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MENDONCA MEZZOMO",
        "first_name": "LUIS ANDRE",
        "credential": "DR.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2024-02-14",
        "last_updated": "2024-02-16",
        "certification_date": "2024-02-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0700X",
            "taxonomy_group": "",
            "desc": "Dentist, Prosthodontics",
            "state": "IL",
            "license": "136000272",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "IL",
            "license": "136000272",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ginalyn G Mendillo
• Mending Spot PLLC
• Michelle Alexandra Mendiola-Pla, MD
• Janelle Mendiola, RN
• Mark Anthony Manuel Mendiola, D.D.S.
• Rohini Hilaire Mendonca, MD
• Cristian Mendoza Jarquin, M.S., RDN, LDN
• Cynthia Azucena Mendoza Lizarraga
• Ana Michelle Mendoza Lopez, PA
• Nasya Mendoza-Elias

• 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 Feb 16, 2024; 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.