Provider Demographics
NPI:1184135220
Name:MANDALA, NAIMISHA REDDY (DDS)
Entity type:Individual
Prefix:DR
First Name:NAIMISHA
Middle Name:REDDY
Last Name:MANDALA
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 1:613 GREYWELL CT
Mailing Address - Street 2:
Mailing Address - City:GREER
Mailing Address - State:SC
Mailing Address - Zip Code:29651-7018
Mailing Address - Country:US
Mailing Address - Phone:864-386-5729
Mailing Address - Fax:
Practice Address - Street 1:2125 E MAIN ST STE 500
Practice Address - Street 2:
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29307-1457
Practice Address - Country:US
Practice Address - Phone:864-285-3617
Practice Address - Fax:864-285-3618
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-17
Last Update Date:2022-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC9036122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist