Provider Demographics
NPI:1316675408
Name:MANDALAYWALA, ADITI KIRTIKUMAR (DMD)
Entity type:Individual
Prefix:DR
First Name:ADITI
Middle Name:KIRTIKUMAR
Last Name:MANDALAYWALA
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 1:78 MCKINLEY AVE
Mailing Address - Street 2:
Mailing Address - City:ALBERTSON
Mailing Address - State:NY
Mailing Address - Zip Code:11507-1844
Mailing Address - Country:US
Mailing Address - Phone:516-637-6515
Mailing Address - Fax:
Practice Address - Street 1:10000 COMMONS ST
Practice Address - Street 2:
Practice Address - City:LONE TREE
Practice Address - State:CO
Practice Address - Zip Code:80124-5501
Practice Address - Country:US
Practice Address - Phone:303-790-8080
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-08
Last Update Date:2022-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODEN.002051921223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice