Provider Demographics
NPI:1982672929
Name:MANDALINICH, DAVID (DDS)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:MANDALINICH
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1817 PEMBROKE RD
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27408-7901
Mailing Address - Country:US
Mailing Address - Phone:336-275-6144
Mailing Address - Fax:336-373-0119
Practice Address - Street 1:1817 PEMBROKE RD
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27408-7901
Practice Address - Country:US
Practice Address - Phone:336-275-6144
Practice Address - Fax:336-373-0119
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-08
Last Update Date:2008-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC53121223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice