Provider Demographics
NPI:1326613423
Name:DRIVER, MANDIE (DDS)
Entity Type:Individual
Prefix:DR
First Name:MANDIE
Middle Name:
Last Name:DRIVER
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 1:37279 MARKET PLACE DR
Mailing Address - Street 2:
Mailing Address - City:PRAIRIEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70769-3487
Mailing Address - Country:US
Mailing Address - Phone:225-673-1647
Mailing Address - Fax:
Practice Address - Street 1:37279 MARKET PLACE DR
Practice Address - Street 2:
Practice Address - City:PRAIRIEVILLE
Practice Address - State:LA
Practice Address - Zip Code:70769-3487
Practice Address - Country:US
Practice Address - Phone:225-673-1647
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-21
Last Update Date:2021-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA7182122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist