Basic Information
| Provider Information | |||||||||
| NPI: | 1942619549 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MENDEZ | ||||||||
| FirstName: | BRANDON | ||||||||
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| Credential: | DDS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 600 CAISSON HILL RD | ||||||||
| Address2: | US ARMY DENTAL ACTIVITY | ||||||||
| City: | FORT RILEY | ||||||||
| State: | KS | ||||||||
| PostalCode: | 664427037 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7852397241 | ||||||||
| FaxNumber: | 7852405749 | ||||||||
| Practice Location | |||||||||
| Address1: | 4000 E CAMPUS LOOP | ||||||||
| Address2: | UNIVERSITY OF NEBRASKA MEDICAL CENTER | ||||||||
| City: | LINCOLN | ||||||||
| State: | NE | ||||||||
| PostalCode: | 68583 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4024271333 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/07/2014 | ||||||||
| LastUpdateDate: | 06/25/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 122300000X | 60977 | KS | N | Dental Providers | Dentist | 122300000X | 7528 | NE | Y | Dental Providers | Dentist |
No ID Information.