Provider Demographics
NPI:1932862935
Name:MANDO, TALA (DDS)
Entity Type:Individual
Prefix:DR
First Name:TALA
Middle Name:
Last Name:MANDO
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 1:27951 BRADFORD RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77494-3707
Mailing Address - Country:US
Mailing Address - Phone:681-212-9077
Mailing Address - Fax:
Practice Address - Street 1:2225 N SHEPHERD DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77008-1953
Practice Address - Country:US
Practice Address - Phone:281-241-8834
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-16
Last Update Date:2021-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX37915122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist