Provider Demographics
NPI:1821285065
Name:MANDHANI, ANJU N (DDS)
Entity Type:Individual
Prefix:DR
First Name:ANJU
Middle Name:N
Last Name:MANDHANI
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1500 E SOUTHMORE AVE
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:TX
Mailing Address - Zip Code:77502-1314
Mailing Address - Country:US
Mailing Address - Phone:713-944-6800
Mailing Address - Fax:713-472-6101
Practice Address - Street 1:5505 W OREM DR STE 200
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77085-1277
Practice Address - Country:US
Practice Address - Phone:713-723-9200
Practice Address - Fax:713-723-9202
Is Sole Proprietor?:No
Enumeration Date:2007-10-02
Last Update Date:2024-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX230531223G0001X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1872541-05Medicaid
TX1872541-03Medicaid