Healthcare Provider Details

I. General information

NPI: 1881967610
Provider Name (Legal Business Name): MANDEEP VERMANI DDS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/09/2012
Last Update Date: 04/01/2021
Certification Date: 04/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

455 N MESA DR STE 11
MESA AZ
85201-5936
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 Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: MANDEEP VERMANI
Title or Position: MEMBER
Credential: DDS
Phone: 602-741-4388