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General NPI Number Information
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NPI Number | 1497375042
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Entity Type | Organization
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Legal Business Name | MAHTAB SAADATMANDI,DMD, A DENTAL CORPORATION
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Dates
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Enumeration Date | 04/23/2020
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Last Update Date | 04/15/2021
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Provider Practice Location Address
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Address Line | 1131 E WASHINGTON AVE STE H
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City | ESCONDIDO
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State | CA
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Zip | 92025-2227
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Country | US
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Telephone | 858-357-6777
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Fax |
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Provider Business Mailing Address
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Address Line | 2311 S MELROSE DR
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City | VISTA
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State | CA
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Zip | 92081-8788
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Country | US
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Telephone | 858-357-6777
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Fax |
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Authorized Official
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Title or Position | DENTIST
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Name | DR. MAHTAB SAADATMANDI
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Credential | DMD
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Telephone | 858-357-6777
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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