Provider Demographics
NPI:1922658178
Name:MANN, NATALIE (DDS)
Entity Type:Individual
Prefix:
First Name:NATALIE
Middle Name:
Last Name:MANN
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 1:6021 FOUNTAIN PARK LN APT 7
Mailing Address - Street 2:
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91367-3523
Mailing Address - Country:US
Mailing Address - Phone:818-455-1936
Mailing Address - Fax:
Practice Address - Street 1:405 W FOOTHILL BLVD STE 104
Practice Address - Street 2:
Practice Address - City:CLAREMONT
Practice Address - State:CA
Practice Address - Zip Code:91711-2799
Practice Address - Country:US
Practice Address - Phone:909-626-1236
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-18
Last Update Date:2019-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1041851223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice