Healthcare Provider Details

I. General information

NPI: 1619328796
Provider Name (Legal Business Name): DANIEL MANDIC DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2016
Last Update Date: 07/21/2023
Certification Date: 09/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10151 ESTERO TOWN COMMONS PL UNIT 202
ESTERO FL
33928-9707
US

IV. Provider business mailing address

23 CITY PARK CIRCLE
WOODBRIDGE ONTARIO
L4L 0H2
CA

V. Phone/Fax

Practice location:
  • Phone: 239-990-8231
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDN28298
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number059694
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: