Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 122300000X | Dentist | DI02532800 | NJ |
N | 122300000X | Dentist | DS038801 | PA |
N | 1223D0004X | Dentist Anesthesiologist | DI02532800 | NJ |
Y | 1223D0004X | Dentist Anesthesiologist | DS038801 | PA |
NPI | 1346584299 |
---|---|
Provider Name | Dr. Jonathan Mendia |
First Address | Pittsburgh, PA 15206-4028 |
Second Address | Pittsburgh, PA 15206-4028 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/11/2012 |
Last Update Date | 17/05/2013 |