Provider Demographics
NPI:1548342074
Name:MANDANAS, ROWENA (DDS)
Entity type:Individual
Prefix:
First Name:ROWENA
Middle Name:
Last Name:MANDANAS
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 1:121 W FIREWEED LN
Mailing Address - Street 2:STE 200
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99503-2053
Mailing Address - Country:US
Mailing Address - Phone:907-276-5522
Mailing Address - Fax:907-277-8026
Practice Address - Street 1:121 W FIREWEED LN
Practice Address - Street 2:STE 200
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99503-2053
Practice Address - Country:US
Practice Address - Phone:907-276-5522
Practice Address - Fax:907-277-8026
Is Sole Proprietor?:No
Enumeration Date:2006-10-20
Last Update Date:2010-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK1201122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK1201OtherLICENSED DENTIST