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General NPI Number Information
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NPI Number | 1831365204
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Entity Type | Organization
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Legal Business Name | CHARLES S. MANDELL, D.D.S.,PA
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Dates
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Enumeration Date | 05/05/2008
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Last Update Date | 05/05/2008
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Provider Practice Location Address
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Address Line | 3220 STIRLING RD SUITE 103
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City | HOLLYWOOD
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State | FL
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Zip | 33021-2041
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Country | US
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Telephone | 954-966-0404
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Fax | 954-987-8378
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Provider Business Mailing Address
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Address Line | 3220 STIRLING RD SUITE 103
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City | HOLLYWOOD
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State | FL
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Zip | 33021-2041
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Country | US
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Telephone | 954-966-0404
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Fax | 954-987-8378
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Authorized Official
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Title or Position | OWNER/PRESIDENT
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Name | DR. CHARLES SOLOMON MANDELL
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Credential | D.D.S.
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Telephone | 954-966-0404
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DN3803
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License Number State | FL
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