Provider Demographics
NPI:1831365204
Name:CHARLES S. MANDELL, D.D.S.,PA
Entity type:Organization
Organization Name:CHARLES S. MANDELL, D.D.S.,PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:SOLOMON
Authorized Official - Last Name:MANDELL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:954-966-0404
Mailing Address - Street 1:3220 STIRLING RD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33021-2041
Mailing Address - Country:US
Mailing Address - Phone:954-966-0404
Mailing Address - Fax:954-987-8378
Practice Address - Street 1:3220 STIRLING RD
Practice Address - Street 2:SUITE 103
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021-2041
Practice Address - Country:US
Practice Address - Phone:954-966-0404
Practice Address - Fax:954-987-8378
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-05
Last Update Date:2008-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN3803122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty