Provider Demographics
NPI:1023192358
Name:BAL, MANDEEP (DDS)
Entity Type:Individual
Prefix:DR
First Name:MANDEEP
Middle Name:
Last Name:BAL
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24531 TRABUCO RD STE H
Mailing Address - Street 2:
Mailing Address - City:LAKE FOREST
Mailing Address - State:CA
Mailing Address - Zip Code:92630-2162
Mailing Address - Country:US
Mailing Address - Phone:949-855-3368
Mailing Address - Fax:
Practice Address - Street 1:24531 TRABUCO RD STE H
Practice Address - Street 2:
Practice Address - City:LAKE FOREST
Practice Address - State:CA
Practice Address - Zip Code:92630-2162
Practice Address - Country:US
Practice Address - Phone:949-855-3368
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA377851223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice