Basic Information
| Provider Information | |||||||||
| NPI: | 1922658178 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MANN | ||||||||
| FirstName: | NATALIE | ||||||||
| MiddleName: | |||||||||
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| Credential: | DDS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6021 FOUNTAIN PARK LN APT 7 | ||||||||
| Address2: | |||||||||
| City: | WOODLAND HILLS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 913673523 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8184551936 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 405 W FOOTHILL BLVD STE 104 | ||||||||
| Address2: | |||||||||
| City: | CLAREMONT | ||||||||
| State: | CA | ||||||||
| PostalCode: | 917112799 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9096261236 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/18/2019 | ||||||||
| LastUpdateDate: | 09/18/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1223G0001X | 104185 | CA | Y | Dental Providers | Dentist | General Practice |
No ID Information.