Provider Demographics
NPI:1881859775
Name:MANDERS INC
Entity Type:Organization
Organization Name:MANDERS INC
Other - Org Name:MANDERS DENTAL
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:HOWARD
Authorized Official - Middle Name:D
Authorized Official - Last Name:MANDERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-435-6888
Mailing Address - Street 1:2220 ATLANTA RD SE
Mailing Address - Street 2:SUITE 104
Mailing Address - City:SMYRNA
Mailing Address - State:GA
Mailing Address - Zip Code:30080-1583
Mailing Address - Country:US
Mailing Address - Phone:770-435-6888
Mailing Address - Fax:770-435-6888
Practice Address - Street 1:2220 ATLANTA RD SE
Practice Address - Street 2:SUITE 104
Practice Address - City:SMYRNA
Practice Address - State:GA
Practice Address - Zip Code:30080-1583
Practice Address - Country:US
Practice Address - Phone:770-435-6888
Practice Address - Fax:770-435-6888
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-21
Last Update Date:2012-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty