Provider Demographics
NPI:1144068883
Name:MANGAT, AMANDEV (DDS)
Entity type:Individual
Prefix:DR
First Name:AMANDEV
Middle Name:
Last Name:MANGAT
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 1:1385 HIDDEN RANCH DR
Mailing Address - Street 2:
Mailing Address - City:SIMI VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:93063-4564
Mailing Address - Country:US
Mailing Address - Phone:805-428-2755
Mailing Address - Fax:
Practice Address - Street 1:2215 OAK PARK AVE
Practice Address - Street 2:
Practice Address - City:BERWYN
Practice Address - State:IL
Practice Address - Zip Code:60402-2220
Practice Address - Country:US
Practice Address - Phone:888-867-7509
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-17
Last Update Date:2024-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019035334122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist