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General NPI Number Information
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NPI Number | 1962103978
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Entity Type | Individual
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Provider Name | SURYADEEP SINGH MANKATALA DDS
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Gender | Male
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Dates
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Enumeration Date | 03/15/2023
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Last Update Date | 07/11/2025
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Provider Practice Location Address
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Address Line | 4731 CLAIREMONT DR STE 101
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City | SAN DIEGO
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State | CA
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Zip | 92117-2743
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Country | US
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Telephone | 858-272-7300
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Fax |
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Provider Business Mailing Address
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Address Line | 1147 BELLINGHAM DR
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City | OCEANSIDE
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State | CA
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Zip | 92057-2736
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Country | US
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Telephone |
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | 108047
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License Number State | CA
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