Provider Demographics
NPI:1073792156
Name:AKBARIAN, MANDANA (DMD)
Entity Type:Individual
Prefix:DR
First Name:MANDANA
Middle Name:
Last Name:AKBARIAN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5967 SANDOWN PL
Mailing Address - Street 2:
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91739-2429
Mailing Address - Country:US
Mailing Address - Phone:610-308-8296
Mailing Address - Fax:
Practice Address - Street 1:5967 SANDOWN PL
Practice Address - Street 2:
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91739-2429
Practice Address - Country:US
Practice Address - Phone:610-308-8296
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-25
Last Update Date:2012-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA59619122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist