Provider Demographics
NPI:1265520670
Name:MANDELARIS, RICHARD A (DMD)
Entity type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:A
Last Name:MANDELARIS
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 1:1791 OAK AVE
Mailing Address - Street 2:#C
Mailing Address - City:DAVIS
Mailing Address - State:CA
Mailing Address - Zip Code:95616
Mailing Address - Country:US
Mailing Address - Phone:530-756-7516
Mailing Address - Fax:530-756-0727
Practice Address - Street 1:1791 OAK AVE
Practice Address - Street 2:#C
Practice Address - City:DAVIS
Practice Address - State:CA
Practice Address - Zip Code:95616
Practice Address - Country:US
Practice Address - Phone:530-756-7516
Practice Address - Fax:530-756-0727
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA213231223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry