Provider Demographics
NPI:1639249279
Name:MANDI, ARACELI M (DDS)
Entity Type:Individual
Prefix:
First Name:ARACELI
Middle Name:M
Last Name:MANDI
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:MARIA
Other - Middle Name:ARACELI
Other - Last Name:MANDI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:1620 W MAGNOLIA BLVD
Mailing Address - Street 2:
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91506-1838
Mailing Address - Country:US
Mailing Address - Phone:818-588-3075
Mailing Address - Fax:818-588-3560
Practice Address - Street 1:1620 W MAGNOLIA BLVD
Practice Address - Street 2:
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91506-1838
Practice Address - Country:US
Practice Address - Phone:818-588-3075
Practice Address - Fax:818-588-3560
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-09
Last Update Date:2016-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA443371223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB4433701OtherMEDI CAL