Provider Demographics
NPI:1245603208
Name:MANDALIA, NEIL (DMD)
Entity Type:Individual
Prefix:DR
First Name:NEIL
Middle Name:
Last Name:MANDALIA
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1651 AMERICAN PACIFIC DR
Mailing Address - Street 2:APT 16203
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89074-7601
Mailing Address - Country:US
Mailing Address - Phone:267-394-0828
Mailing Address - Fax:
Practice Address - Street 1:1651 AMERICAN PACIFIC DR
Practice Address - Street 2:APT 16203
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89074-7601
Practice Address - Country:US
Practice Address - Phone:267-394-0828
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-11-12
Last Update Date:2015-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV6695122300000X
PADS040144122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist