Provider Demographics
NPI:1568567501
Name:THADDEUS J. MANDATO, D.D.S., INC.
Entity Type:Organization
Organization Name:THADDEUS J. MANDATO, D.D.S., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:THADDEUS JUDE
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:MANDATO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:440-331-0164
Mailing Address - Street 1:21245 LORAIN RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:FAIRVIEW PARK
Mailing Address - State:OH
Mailing Address - Zip Code:44126-2146
Mailing Address - Country:US
Mailing Address - Phone:440-331-0164
Mailing Address - Fax:440-331-0165
Practice Address - Street 1:21245 LORAIN RD
Practice Address - Street 2:SUITE 100
Practice Address - City:FAIRVIEW PARK
Practice Address - State:OH
Practice Address - Zip Code:44126-2146
Practice Address - Country:US
Practice Address - Phone:440-331-0164
Practice Address - Fax:440-331-0165
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty