Healthcare Provider Details

I. General information

NPI: 1548327604
Provider Name (Legal Business Name): ROBERT LINDSAY MANDELL D.M. D. , M.M.SC.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/01/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

164 WESTFORD RD SUITE 8
TYNGSBORO MA
01879-2530
US

IV. Provider business mailing address

441 LOWELL ST
READING MA
01867-1533
US

V. Phone/Fax

Practice location:
  • Phone: 978-649-3058
  • Fax: 978-649-9566
Mailing address:
  • Phone: 781-942-0190
  • Fax: 781-944-5258

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number13306
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: