Provider Demographics
NPI:1255888392
Name:MANDALI, BHUPESH KIRAN (BDS/DDS)
Entity type:Individual
Prefix:DR
First Name:BHUPESH KIRAN
Middle Name:
Last Name:MANDALI
Suffix:
Gender:M
Credentials:BDS/DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6343 TOWNSHIP ROAD 136
Mailing Address - Street 2:
Mailing Address - City:FINDLAY
Mailing Address - State:OH
Mailing Address - Zip Code:45840-9675
Mailing Address - Country:US
Mailing Address - Phone:618-407-8258
Mailing Address - Fax:
Practice Address - Street 1:130 WAYNE FRYE DR
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:OH
Practice Address - Zip Code:45144-9314
Practice Address - Country:US
Practice Address - Phone:937-549-1279
Practice Address - Fax:937-549-1286
Is Sole Proprietor?:No
Enumeration Date:2016-09-07
Last Update Date:2021-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30.026273122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0425651Medicaid