Provider Demographics
NPI:1912020595
Name:SIMI CHILDRENS DENTAL GROUP
Entity Type:Organization
Organization Name:SIMI CHILDRENS DENTAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NINA
Authorized Official - Middle Name:
Authorized Official - Last Name:MANDELMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:805-522-2164
Mailing Address - Street 1:1755 ERRINGER RD
Mailing Address - Street 2:SUITE 20
Mailing Address - City:SIMI VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:93065-6507
Mailing Address - Country:US
Mailing Address - Phone:805-522-2164
Mailing Address - Fax:805-522-9849
Practice Address - Street 1:1755 ERRINGER RD
Practice Address - Street 2:SUITE 20
Practice Address - City:SIMI VALLEY
Practice Address - State:CA
Practice Address - Zip Code:93065-6507
Practice Address - Country:US
Practice Address - Phone:805-522-2164
Practice Address - Fax:805-522-9849
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAD 449361223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty