Provider Demographics
NPI:1366751364
Name:KHALATBARI, MANDANA (DDS)
Entity type:Individual
Prefix:
First Name:MANDANA
Middle Name:
Last Name:KHALATBARI
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 MANDRAKE WAY
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92612-2713
Mailing Address - Country:US
Mailing Address - Phone:646-284-4746
Mailing Address - Fax:
Practice Address - Street 1:14119 PIONEER BLVD
Practice Address - Street 2:
Practice Address - City:NORWALK
Practice Address - State:CA
Practice Address - Zip Code:90650-3925
Practice Address - Country:US
Practice Address - Phone:562-929-2383
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-25
Last Update Date:2025-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADDS1012311223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice