Provider Demographics
NPI:1720091630
Name:RICHARD A MANDEL, DDS INC
Entity Type:Organization
Organization Name:RICHARD A MANDEL, DDS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:A
Authorized Official - Last Name:MANDEL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:714-835-8873
Mailing Address - Street 1:801 N TUSTIN AVE SUITE 705
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92705
Mailing Address - Country:US
Mailing Address - Phone:714-835-8873
Mailing Address - Fax:714-835-0402
Practice Address - Street 1:801 N TUSTIN AVE SUITE 705
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92705
Practice Address - Country:US
Practice Address - Phone:714-835-8873
Practice Address - Fax:714-835-0402
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-14
Last Update Date:2008-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA21384204E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial SurgeryGroup - Single Specialty