Provider Demographics
NPI:1831539725
Name:MANDA, SWAPNA
Entity type:Individual
Prefix:
First Name:SWAPNA
Middle Name:
Last Name:MANDA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7713 SWEETGUM DR
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75063-3482
Mailing Address - Country:US
Mailing Address - Phone:214-991-4619
Mailing Address - Fax:
Practice Address - Street 1:1460 PRECINCT LINE RD
Practice Address - Street 2:
Practice Address - City:HURST
Practice Address - State:TX
Practice Address - Zip Code:76053-3976
Practice Address - Country:US
Practice Address - Phone:682-253-3147
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-25
Last Update Date:2025-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX292321223G0001X
CA624571223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice