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General NPI Number Information
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NPI Number | 1689961609
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Entity Type | Individual
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Provider Name | SAI GUNA RANJAN MANDAVA DDS
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Gender | Male
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Dates
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Enumeration Date | 06/29/2011
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Last Update Date | 12/08/2016
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Provider Practice Location Address
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Address Line | 4660 VETERANS MEMORIAL DR SUITE F-1
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City | BATAVIA
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State | NY
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Zip | 14020-1298
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Country | US
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Telephone | 585-344-8413
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Fax |
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Provider Business Mailing Address
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Address Line | 281 SANDERS CREEK PKWY
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City | EAST SYRACUSE
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State | NY
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Zip | 13057-1307
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Country | US
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Telephone | 315-454-6000
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 9337
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License Number State | TN
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