Provider Demographics
NPI:1346462215
Name:MANDICH, SABRINA MARIE (DDS)
Entity Type:Individual
Prefix:DR
First Name:SABRINA
Middle Name:MARIE
Last Name:MANDICH
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 1:207 - SW 156TH ST., SUITE #1
Mailing Address - Street 2:
Mailing Address - City:BURIEN
Mailing Address - State:WA
Mailing Address - Zip Code:98166-2561
Mailing Address - Country:US
Mailing Address - Phone:206-246-1000
Mailing Address - Fax:206-444-4815
Practice Address - Street 1:207 - SW 156TH STREET
Practice Address - Street 2:SUITE #1
Practice Address - City:BURIEN
Practice Address - State:WA
Practice Address - Zip Code:98166-2561
Practice Address - Country:US
Practice Address - Phone:206-246-1000
Practice Address - Fax:206-444-4815
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60081223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice