Provider Demographics
NPI:1942619549
Name:MENDEZ, BRANDON (DDS)
Entity type:Individual
Prefix:
First Name:BRANDON
Middle Name:
Last Name:MENDEZ
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 CAISSON HILL RD
Mailing Address - Street 2:US ARMY DENTAL ACTIVITY
Mailing Address - City:FORT RILEY
Mailing Address - State:KS
Mailing Address - Zip Code:66442-7037
Mailing Address - Country:US
Mailing Address - Phone:785-239-7241
Mailing Address - Fax:785-240-5749
Practice Address - Street 1:4000 E CAMPUS LOOP
Practice Address - Street 2:UNIVERSITY OF NEBRASKA MEDICAL CENTER
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68583
Practice Address - Country:US
Practice Address - Phone:402-427-1333
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-07
Last Update Date:2019-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS60977122300000X
NE7528122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist