Provider Demographics
NPI:1316274749
Name:SAADATMANDI, MAHTAB (DMD)
Entity type:Individual
Prefix:DR
First Name:MAHTAB
Middle Name:
Last Name:SAADATMANDI
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2311 S. MELROSE DR.
Mailing Address - Street 2:
Mailing Address - City:VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:92081
Mailing Address - Country:US
Mailing Address - Phone:760-599-1100
Mailing Address - Fax:760-599-1102
Practice Address - Street 1:2311 S. MELROSE DR.
Practice Address - Street 2:
Practice Address - City:VISTA
Practice Address - State:CA
Practice Address - Zip Code:92081
Practice Address - Country:US
Practice Address - Phone:760-599-1100
Practice Address - Fax:760-599-1102
Is Sole Proprietor?:No
Enumeration Date:2009-11-05
Last Update Date:2011-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA550051223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice