Healthcare Provider Details

I. General information

NPI: 1164344354
Provider Name (Legal Business Name): MANDI MCGILVRAY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MANDI JEANETTE BELDEN

II. Dates (important events)

Enumeration Date: 07/28/2026
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

207 N BUTTE ST
WILLOWS CA
95988-2803
US

IV. Provider business mailing address

2140 LARKIN RD
BIGGS CA
95917-9720
US

V. Phone/Fax

Practice location:
  • Phone: 530-934-4641
  • Fax:
Mailing address:
  • Phone: 530-990-1834
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number37247
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: