Provider Demographics
NPI:1497185540
Name:MANDEL, BENJAMIN J (DDS)
Entity Type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:J
Last Name:MANDEL
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:BEN
Other - Middle Name:
Other - Last Name:MANDEL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS, INC
Mailing Address - Street 1:3835 AVOCADO BLVD #220
Mailing Address - Street 2:
Mailing Address - City:LAMESA
Mailing Address - State:CA
Mailing Address - Zip Code:91941
Mailing Address - Country:US
Mailing Address - Phone:619-660-0022
Mailing Address - Fax:619-660-2525
Practice Address - Street 1:3835 AVOCADO BLVD #220
Practice Address - Street 2:
Practice Address - City:LAMESA
Practice Address - State:CA
Practice Address - Zip Code:91941
Practice Address - Country:US
Practice Address - Phone:619-660-0022
Practice Address - Fax:619-660-2525
Is Sole Proprietor?:No
Enumeration Date:2013-11-26
Last Update Date:2013-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA254201223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice