Provider Demographics
NPI:1699895417
Name:MANDEL, BRUCE P (DDS)
Entity type:Individual
Prefix:
First Name:BRUCE
Middle Name:P
Last Name:MANDEL
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:66 PAINTERS MILL RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:OWINGS MILLS
Mailing Address - State:MD
Mailing Address - Zip Code:21117-3641
Mailing Address - Country:US
Mailing Address - Phone:410-363-3780
Mailing Address - Fax:410-356-1171
Practice Address - Street 1:66 PAINTERS MILL RD
Practice Address - Street 2:SUITE 100
Practice Address - City:OWINGS MILLS
Practice Address - State:MD
Practice Address - Zip Code:21117-3641
Practice Address - Country:US
Practice Address - Phone:410-363-3780
Practice Address - Fax:410-356-1171
Is Sole Proprietor?:No
Enumeration Date:2007-03-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD69801223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD6980OtherDENTAL LICENSE