Provider Demographics
NPI:1235418161
Name:MANDEEP VERMANI DDS PLLC
Entity Type:Organization
Organization Name:MANDEEP VERMANI DDS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:MANDEEP
Authorized Official - Middle Name:
Authorized Official - Last Name:VERMANI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:623-428-9949
Mailing Address - Street 1:PO BOX 22270
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85028-0270
Mailing Address - Country:US
Mailing Address - Phone:623-428-9949
Mailing Address - Fax:623-428-9962
Practice Address - Street 1:1911 W MAIN ST STE 6
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85201-6929
Practice Address - Country:US
Practice Address - Phone:623-428-9949
Practice Address - Fax:623-428-9962
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-09
Last Update Date:2019-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD069201223G0001X
332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ147584Medicare PIN