Provider Demographics
NPI:1245574078
Name:ROWENA MANDANAS, DDS, INC
Entity type:Organization
Organization Name:ROWENA MANDANAS, DDS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROWENA
Authorized Official - Middle Name:
Authorized Official - Last Name:MANDANAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-276-5522
Mailing Address - Street 1:121 W FIREWEED LN
Mailing Address - Street 2:STE 200
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99503-2053
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:121 W FIREWEED LN
Practice Address - Street 2:STE 200
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99503-2053
Practice Address - Country:US
Practice Address - Phone:907-276-5522
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-16
Last Update Date:2012-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK1201122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty