Provider Demographics
NPI:1669593240
Name:MANDAPAT, TERESITA H (DDS)
Entity type:Individual
Prefix:DR
First Name:TERESITA
Middle Name:H
Last Name:MANDAPAT
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:MRS
Other - First Name:TERESITA
Other - Middle Name:H
Other - Last Name:HARM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:1006 FRYAR AVE STE A
Mailing Address - Street 2:
Mailing Address - City:SUMNER
Mailing Address - State:WA
Mailing Address - Zip Code:98390-1501
Mailing Address - Country:US
Mailing Address - Phone:253-863-8138
Mailing Address - Fax:253-863-4930
Practice Address - Street 1:1006 FRYAR AVE STE A
Practice Address - Street 2:
Practice Address - City:SUMNER
Practice Address - State:WA
Practice Address - Zip Code:98390-1501
Practice Address - Country:US
Practice Address - Phone:253-863-8138
Practice Address - Fax:253-863-4930
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA6430122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist