Provider Demographics
NPI:1841892510
Name:SANDEEP MANN RDHAP INC.
Entity type:Organization
Organization Name:SANDEEP MANN RDHAP INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SANDEEP
Authorized Official - Middle Name:K
Authorized Official - Last Name:MANN
Authorized Official - Suffix:
Authorized Official - Credentials:RDHAP
Authorized Official - Phone:209-534-7959
Mailing Address - Street 1:3384 AMY DR
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92882-8794
Mailing Address - Country:US
Mailing Address - Phone:209-534-7959
Mailing Address - Fax:
Practice Address - Street 1:3384 AMY DR
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92882-8794
Practice Address - Country:US
Practice Address - Phone:704-732-6204
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-09
Last Update Date:2020-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes125K00000XDental ProvidersAdvanced Practice Dental TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1871091173Medicaid