Provider Demographics
NPI:1205810124
Name:MANDEL, JOHN D (DMD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:D
Last Name:MANDEL
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:63 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:NORWOOD
Mailing Address - State:MA
Mailing Address - Zip Code:02062-3558
Mailing Address - Country:US
Mailing Address - Phone:781-762-0053
Mailing Address - Fax:781-769-9229
Practice Address - Street 1:63 BROADWAY
Practice Address - Street 2:
Practice Address - City:NORWOOD
Practice Address - State:MA
Practice Address - Zip Code:02062-3558
Practice Address - Country:US
Practice Address - Phone:781-762-0053
Practice Address - Fax:781-769-9229
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10584122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist