Bruce P. Mandel, D.D.S.

Primary specialty

PeriodonticsTaxonomy code 1223P0300X

License

6980 Issued in MD

Practice address

66 Painters Mill Rd
Suite 100
Owings Mills, MD 21117-3641

Phone

(410) 363-3780

Fax

(410) 356-1171

NPI assigned

Mar 29, 2007

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in MD

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1175126400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1699895417",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "66 PAINTERS MILL RD",
            "address_2": "SUITE 100",
            "city": "OWINGS MILLS",
            "state": "MD",
            "postal_code": "211173641",
            "telephone_number": "410-363-3780",
            "fax_number": "410-356-1171"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "66 PAINTERS MILL RD",
            "address_2": "SUITE 100",
            "city": "OWINGS MILLS",
            "state": "MD",
            "postal_code": "211173641",
            "telephone_number": "410-363-3780",
            "fax_number": "410-356-1171"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MANDEL",
        "first_name": "BRUCE",
        "middle_name": "P.",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-03-29",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0300X",
            "taxonomy_group": "",
            "desc": "Dentist, Periodontics",
            "state": "MD",
            "license": "6980",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DENTAL LICENSE",
            "identifier": "6980",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Mallare and Associates, LLC
• Stacy S Mallare
• Tatyana Maltseva, LIC. ACUPUNCTURIST
• Rebecca Mancoll
• Alisa Perle Mandel, O.D.
• Ira Mandell, M.D.
• Jonathan Scott Mandras, D.D.S.
• Genevieve Manger
• Recairdo Demetrius Mangrum, PH.D.
• Tasha Manigo-Bizzell, LDN

• Periodontics in Owings Mills, MD
• Providers in Owings Mills, MD by specialty
• Periodontics in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.