Provider Demographics
NPI:1003033440
Name:MANDELL, CHARLES SOLOMON (DDS)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:SOLOMON
Last Name:MANDELL
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3220 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
Is Sole Proprietor?:No
Enumeration Date:2007-04-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 38031223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice