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NPI Code Detail

MEDICARE: DR. MANDEEP BAL D.D.S.

MEDICARE:  DR. MANDEEP  BAL  D.D.S.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11223G0001XGeneral Practice Dentistry37785CA

General Provider Information

NPI Number : 1023192358
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MANDEEP BAL D.D.S.
Provider Business Mailing Address
First Line : 24531 TRABUCO RD STE H
Second Line :
City : LAKE FOREST
State : CA
Zip : 92630-2162
Country : US
Telephone Number : 949-855-3368
Fax Number :
Provider Business Practice Location Address
First Line : 24531 TRABUCO RD STE H
Second Line :
City : LAKE FOREST
State : CA
Zip : 92630-2162
Country : US
Telephone Number : 949-855-3368
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/24/2006
Last Update Date : 07/08/2007

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Directions to “ DR. MANDEEP BAL D.D.S.” Practice Location

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