Edward Bryce Mandel – General Practice Dentistry

Key facts

NPI: 1487023255
Entity type: Individual (NPI type 1)
Primary specialty: General Practice Dentistry 1223G0001X
License: DN13978 (FL)
Practice address: 101 Lecom Way
Lake Erie College of Osteopathic Medicine
Defuniak Springs, FL 32435
Phone: (850) 951-0200
NPI assigned: Sep 22, 2015
Sex: Male
Sole proprietor: No

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Lake Erie College of Osteopathic Medicine General Practice Dentistry · Defuniak Springs, FL · NPI 1710422670

NPD (past) GENERAL PRACTICE

Medicare participation

Medicare fee-for-service enrollment: Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD): No
Credentials: Master of Science

State licenses

License	State	Type	Specialty
DN13978	FL	MD	General Practice Dentistry

Practice roles

Organization	Specialty	Status	New patients
Lake Erie College of Osteopathic Medicine	General Practice	Past	Accepting new patients

Specialties & licenses

Specialty (taxonomy)	Code	License	State	Primary
General Practice Dentistry	1223G0001X	DN13978	FL	Yes

Addresses

Primary practice location

101 Lecom Way
Lake Erie College of Osteopathic Medicine
Defuniak Springs, FL 32435

Mailing address

101 Lecom Way
Lake Erie College of Osteopathic Medicine
Defuniak Springs, FL 32435
Phone (850) 951-0200

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Sep 22, 2015.

{
    "created_epoch": "1442880000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1442880000000",
    "number": "1487023255",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "101 LECOM WAY",
            "address_2": "LAKE ERIE COLLEGE OF OSTEOPATHIC MEDICINE",
            "city": "DEFUNIAK SPRINGS",
            "state": "FL",
            "postal_code": "32435",
            "telephone_number": "850-951-0200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101 LECOM WAY",
            "address_2": "LAKE ERIE COLLEGE OF OSTEOPATHIC MEDICINE",
            "city": "DEFUNIAK SPRINGS",
            "state": "FL",
            "postal_code": "32435",
            "telephone_number": "850-951-0200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MANDEL",
        "first_name": "EDWARD",
        "middle_name": "BRYCE",
        "name_prefix": "Dr.",
        "credential": "D.D.S., M.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-09-22",
        "last_updated": "2015-09-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "FL",
            "license": "DN13978",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Defuniak Springs, FL

All providers in Defuniak Springs, FL · General Practice Dentistry in Florida

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 22, 2015. Information in NPPES is self-reported and not verified by CMS.
NUCC Health Care Provider Taxonomy: specialty names.
National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.