Provider Demographics
NPI:1881161479
Name:MANN, AMANINDER (RDH, BS)
Entity type:Individual
Prefix:
First Name:AMANINDER
Middle Name:
Last Name:MANN
Suffix:
Gender:M
Credentials:RDH, BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1545 SAINT MARKS PLZ STE 1
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95207-6411
Mailing Address - Country:US
Mailing Address - Phone:209-373-3372
Mailing Address - Fax:
Practice Address - Street 1:7210 MURRAY DR
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95210-3339
Practice Address - Country:US
Practice Address - Phone:209-373-2816
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-01
Last Update Date:2018-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARDH29420124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist