Provider Demographics
NPI:1154832111
Name:SITAL MANDALIA DDS INC
Entity Type:Organization
Organization Name:SITAL MANDALIA DDS INC
Other - Org Name:ORACARE DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SITAL
Authorized Official - Middle Name:
Authorized Official - Last Name:MANDALIA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:562-569-5808
Mailing Address - Street 1:724 N ROSE DR
Mailing Address - Street 2:
Mailing Address - City:PLACENTIA
Mailing Address - State:CA
Mailing Address - Zip Code:92870-7520
Mailing Address - Country:US
Mailing Address - Phone:562-569-5808
Mailing Address - Fax:
Practice Address - Street 1:724 N ROSE DR
Practice Address - Street 2:
Practice Address - City:PLACENTIA
Practice Address - State:CA
Practice Address - Zip Code:92870-7520
Practice Address - Country:US
Practice Address - Phone:562-569-5808
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-18
Last Update Date:2017-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA63042122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
No1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty