Provider Demographics
NPI:1629117783
Name:BEN MANDEL DDS INC
Entity Type:Organization
Organization Name:BEN MANDEL DDS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:JORGE
Authorized Official - Last Name:MANDEL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:619-660-0022
Mailing Address - Street 1:3755 AVOCADO BLVD
Mailing Address - Street 2:#522
Mailing Address - City:LA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:91941-7301
Mailing Address - Country:US
Mailing Address - Phone:619-660-0022
Mailing Address - Fax:619-660-2525
Practice Address - Street 1:3835 AVOCADO BLVD
Practice Address - Street 2:SUITE 220
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91941-7383
Practice Address - Country:US
Practice Address - Phone:619-660-0022
Practice Address - Fax:619-660-2525
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA25420122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty