Provider Demographics
NPI:1114606647
Name:MAMBRINI SOLDATELLI, MARIANA (DDS)
Entity Type:Individual
Prefix:
First Name:MARIANA
Middle Name:
Last Name:MAMBRINI SOLDATELLI
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 1:415 N 26TH ST STE 303
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:IN
Mailing Address - Zip Code:47904-2893
Mailing Address - Country:US
Mailing Address - Phone:765-447-9319
Mailing Address - Fax:765-447-7227
Practice Address - Street 1:415 N 26TH ST STE 303
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47904-2893
Practice Address - Country:US
Practice Address - Phone:765-447-9319
Practice Address - Fax:765-447-7227
Is Sole Proprietor?:No
Enumeration Date:2023-07-12
Last Update Date:2023-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12014175A1223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics