MEDICARE: DR. ANJU N MANDHANI DDS

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
1	1223G0001X	General Practice Dentistry	23053	TX
2	122300000X	Dentist	23053	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1821285065
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANJU N MANDHANI DDS

Provider Business Mailing Address
First Line	:	1500 E SOUTHMORE AVE
Second Line	:
City	:	PASADENA
State	:	TX
Zip	:	77502-1314
Country	:	US
Telephone Number	:	713-944-6800
Fax Number	:	713-472-6101

Provider Business Practice Location Address
First Line	:	5505 W OREM DR STE 200
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77085-1277
Country	:	US
Telephone Number	:	713-723-9200
Fax Number	:	713-723-9202

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/02/2007
Last Update Date	:	02/16/2024

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