Healthcare Provider Details

I. General information

NPI: 1235418161
Provider Name (Legal Business Name): MANDEEP VERMANI DDS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/09/2011
Last Update Date: 05/03/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1911 W MAIN ST STE 6
MESA AZ
85201-6929
US

IV. Provider business mailing address

PO BOX 22270
PHOENIX AZ
85028-0270
US

V. Phone/Fax

Practice location:
  • Phone: 623-428-9949
  • Fax: 623-428-9962
Mailing address:
  • Phone: 623-428-9949
  • Fax: 623-428-9962

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberD06920
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: MANDEEP VERMANI
Title or Position: OWNER/MEMBER
Credential: DDS
Phone: 623-428-9949