Provider Demographics
NPI:1225201569
Name:DR VINODKUMAR H. MANDALIA DDS
Entity Type:Organization
Organization Name:DR VINODKUMAR H. MANDALIA DDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:VINODKUMAR
Authorized Official - Middle Name:H
Authorized Official - Last Name:MANDALIA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:215-357-5666
Mailing Address - Street 1:826 BUSTLETON PIKE
Mailing Address - Street 2:
Mailing Address - City:FEASTERVILLE TREVOSE
Mailing Address - State:PA
Mailing Address - Zip Code:19053-6064
Mailing Address - Country:US
Mailing Address - Phone:215-357-5666
Mailing Address - Fax:215-357-0353
Practice Address - Street 1:826 BUSTLETON PIKE
Practice Address - Street 2:
Practice Address - City:FEASTERVILLE TREVOSE
Practice Address - State:PA
Practice Address - Zip Code:19053-6064
Practice Address - Country:US
Practice Address - Phone:215-357-5666
Practice Address - Fax:215-357-0353
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-08
Last Update Date:2008-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS020610-L122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PADS020610-LOtherDENTIST