Provider Demographics
NPI:1952535510
Name:MANDRADJIEFF, MARIN (DMD)
Entity Type:Individual
Prefix:DR
First Name:MARIN
Middle Name:
Last Name:MANDRADJIEFF
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3501 TERRACE STREET
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15261
Mailing Address - Country:US
Mailing Address - Phone:412-648-1023
Mailing Address - Fax:412-383-7796
Practice Address - Street 1:3501 TERRACE STREET
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15261
Practice Address - Country:US
Practice Address - Phone:412-648-1023
Practice Address - Fax:412-383-7796
Is Sole Proprietor?:No
Enumeration Date:2009-05-12
Last Update Date:2009-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS 020676L122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist