Provider Demographics
NPI:1609042522
Name:MANDRAS, JONATHAN SCOTT (DDS)
Entity Type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:SCOTT
Last Name:MANDRAS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 CROSSROADS DR
Mailing Address - Street 2:SUITE 110
Mailing Address - City:OWINGS MILLS
Mailing Address - State:MD
Mailing Address - Zip Code:21117-5419
Mailing Address - Country:US
Mailing Address - Phone:410-363-2500
Mailing Address - Fax:410-363-0006
Practice Address - Street 1:20 CROSSROADS DR
Practice Address - Street 2:SUITE 110
Practice Address - City:OWINGS MILLS
Practice Address - State:MD
Practice Address - Zip Code:21117-5419
Practice Address - Country:US
Practice Address - Phone:410-363-2500
Practice Address - Fax:410-363-0006
Is Sole Proprietor?:No
Enumeration Date:2008-04-30
Last Update Date:2008-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD143171223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice