Provider Demographics
NPI:1689117996
Name:ALAMWALA, MANDEEP MANDY (DMD)
Entity Type:Individual
Prefix:
First Name:MANDEEP MANDY
Middle Name:
Last Name:ALAMWALA
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 1:3660 LINDSAY RD
Mailing Address - Street 2:
Mailing Address - City:EVERSON
Mailing Address - State:WA
Mailing Address - Zip Code:98247-9250
Mailing Address - Country:US
Mailing Address - Phone:360-393-2158
Mailing Address - Fax:
Practice Address - Street 1:3660 LINDSAY RD
Practice Address - Street 2:
Practice Address - City:EVERSON
Practice Address - State:WA
Practice Address - Zip Code:98247-9250
Practice Address - Country:US
Practice Address - Phone:360-393-2158
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-18
Last Update Date:2019-12-11
Deactivation Date:2019-02-27
Deactivation Code:
Reactivation Date:2019-12-11
Provider Licenses
StateLicense IDTaxonomies
WADE60681890122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist