Provider Demographics
NPI:1538313184
Name:MANKAD, ILA N (DMD)
Entity Type:Individual
Prefix:DR
First Name:ILA
Middle Name:N
Last Name:MANKAD
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1140 2ND ST
Mailing Address - Street 2:SUITE D
Mailing Address - City:BRENTWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:94513-2296
Mailing Address - Country:US
Mailing Address - Phone:925-240-7024
Mailing Address - Fax:925-240-7040
Practice Address - Street 1:1140 2ND ST
Practice Address - Street 2:SUITE D
Practice Address - City:BRENTWOOD
Practice Address - State:CA
Practice Address - Zip Code:94513-2296
Practice Address - Country:US
Practice Address - Phone:925-240-7024
Practice Address - Fax:925-240-7040
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-10
Last Update Date:2008-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA567281223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice