Provider Demographics
NPI:1295898054
Name:VERMANI, MANDEEP (DDS)
Entity type:Individual
Prefix:
First Name:MANDEEP
Middle Name:
Last Name:VERMANI
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:PO BOX 22270
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85028-0270
Mailing Address - Country:US
Mailing Address - Phone:623-428-9949
Mailing Address - Fax:623-428-9962
Practice Address - Street 1:455 N MESA DR STE 11
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85201-5936
Practice Address - Country:US
Practice Address - Phone:623-428-9949
Practice Address - Fax:623-428-9962
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-19
Last Update Date:2021-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD69201223G0001X
AZD069201223X2210X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X2210XDental ProvidersDentistOrofacial Pain
No1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ147585Medicare PIN