Provider Demographics
NPI:1447383641
Name:MANDERS, CYNTHIA ANN (DDS)
Entity Type:Individual
Prefix:DR
First Name:CYNTHIA
Middle Name:ANN
Last Name:MANDERS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:115 N DIXIE DR
Mailing Address - Street 2:SUITE 310
Mailing Address - City:LAKE JACKSON
Mailing Address - State:TX
Mailing Address - Zip Code:77566-5903
Mailing Address - Country:US
Mailing Address - Phone:979-297-2308
Mailing Address - Fax:979-297-3737
Practice Address - Street 1:115 N DIXIE DR
Practice Address - Street 2:SUITE 310
Practice Address - City:LAKE JACKSON
Practice Address - State:TX
Practice Address - Zip Code:77566-5903
Practice Address - Country:US
Practice Address - Phone:979-297-2308
Practice Address - Fax:979-297-3737
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX153461223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX76-0337233OtherCIGNA
TX76-0337233OtherMETLIFE
TX76-0337233OtherFISERV BENEFIT PLANNERS
TX76-0337233OtherUNICARE
TX1208175-01Medicaid
TX76-0337233OtherAETNA DENTAL
TXD-15346OtherBCBS OF TEXAS
TX76-0337233OtherDELTA DENTAL
TX76-0337233OtherUNITEDHEALTH CARE
TX76-0337233OtherLIFE RE
TX736506OtherTRICARE DENTAL PROGRAM
TX76-0337233OtherDENTA-CARE