Healthcare Provider Details

I. General information

NPI: 1427795392
Provider Name (Legal Business Name): RAVDEEP SINGH MANN DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/12/2022
Last Update Date: 05/12/2022
Certification Date: 05/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

173 42ND AVE E
VANCOUVER BRITISH COLUMBIA
V5W1S5
CA

IV. Provider business mailing address

173 42ND AVE E
VANCOUVER BRITISH COLUMBIA
V5W1S5
CA

V. Phone/Fax

Practice location:
  • Phone: 778-889-7945
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number019032469
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number019032469
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: