Provider Demographics
NPI:1427767755
Name:MANDARA 3 PLLC
Entity type:Organization
Organization Name:MANDARA 3 PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:BHAVIK
Authorized Official - Middle Name:
Authorized Official - Last Name:MOHANLAL
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:972-951-0470
Mailing Address - Street 1:2205 STENNETT DR
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76006-2807
Mailing Address - Country:US
Mailing Address - Phone:972-951-0470
Mailing Address - Fax:
Practice Address - Street 1:1908 CENTRAL DR STE D
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:TX
Practice Address - Zip Code:76021-5822
Practice Address - Country:US
Practice Address - Phone:817-285-5880
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-15
Last Update Date:2024-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1134893233Medicaid
TX1427767755Medicaid