Provider Demographics
NPI:1760575377
Name:MANDEL, RICHARD CHARLES (DMD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:CHARLES
Last Name:MANDEL
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 E WOODLAND AVE
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:PA
Mailing Address - Zip Code:19064-2914
Mailing Address - Country:US
Mailing Address - Phone:610-328-6144
Mailing Address - Fax:610-328-4745
Practice Address - Street 1:200 E WOODLAND AVE
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:PA
Practice Address - Zip Code:19064-2914
Practice Address - Country:US
Practice Address - Phone:610-543-1458
Practice Address - Fax:610-328-4745
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2020-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC012509101YP2500X
PADS021080L122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional