Provider Demographics
NPI:1730848441
Name:MAND DENTAL CORPORATION
Entity type:Organization
Organization Name:MAND DENTAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BIRINDERJIT
Authorized Official - Middle Name:SINGH
Authorized Official - Last Name:MAND
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:909-982-5960
Mailing Address - Street 1:555 N CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:UPLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91786-4241
Mailing Address - Country:US
Mailing Address - Phone:909-982-5960
Mailing Address - Fax:
Practice Address - Street 1:555 N CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:UPLAND
Practice Address - State:CA
Practice Address - Zip Code:91786-4241
Practice Address - Country:US
Practice Address - Phone:909-982-5960
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-09
Last Update Date:2021-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1841680964Medicaid