Provider Demographics
NPI:1760361836
Name:BONILLA MENDOZA, WENDY P
Entity type:Individual
Prefix:
First Name:WENDY
Middle Name:P
Last Name:BONILLA MENDOZA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8436 MOUNTAIN LAUREL LN
Mailing Address - Street 2:
Mailing Address - City:GAITHERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20879-1555
Mailing Address - Country:US
Mailing Address - Phone:240-755-3145
Mailing Address - Fax:
Practice Address - Street 1:806 W DIAMOND AVE STE 330
Practice Address - Street 2:
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20878-1470
Practice Address - Country:US
Practice Address - Phone:301-838-9300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-09-01
Last Update Date:2025-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD9215124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist