Dr Mandava DDS Family Dentistry PC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Legal business name

DR MANDAVA DDS FAMILY DENTISTRY PC

Practice address

415 Middlebury Rd
Middlebury, CT 06762-2537

Phone

(203) 758-2116

Fax

(203) 758-9522

NPI assigned

Mar 11, 2014

Last updated

Mar 11, 2014By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Ratnakar R Mandava, DDS

Title

President

Phone

(203) 758-2116

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1394496000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1394496000000",
    "number": "1366868697",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "415 MIDDLEBURY RD",
            "city": "MIDDLEBURY",
            "state": "CT",
            "postal_code": "067622537",
            "telephone_number": "203-758-2116",
            "fax_number": "203-758-9522"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "415 MIDDLEBURY RD",
            "city": "MIDDLEBURY",
            "state": "CT",
            "postal_code": "067622537",
            "telephone_number": "203-758-2116",
            "fax_number": "203-758-9522"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DR MANDAVA DDS FAMILY DENTISTRY PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-03-11",
        "last_updated": "2014-03-11",
        "status": "A",
        "authorized_official_last_name": "MANDAVA",
        "authorized_official_first_name": "RATNAKAR",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "203-758-2116",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Joseph Daniel Demayo, M.D.
• Krista Derosa
• Nadia Desimone, SLP
• Maureen A Devlin, RD
• Ayan Mohamed Dirir, LPC, LCPC
• Grace Duke, SLP
• Amy Elizabeth Dumont, LCSW
• Daniel N Dwyer, LCSW
• Dynobite Smiles
• Dynobite Smiles LLC

• General Practice Dentistry in Middlebury, CT
• Providers in Middlebury, CT by specialty
• General Practice Dentistry in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 11, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.