Individual
DR. AMRUTHA CHANDRA MANDAVA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.M.D.
Contact information
Practice address
1662 CENTRAL AVE, ALBANY, NY 12205
(518) 452-2121
(518) 456-2865
Mailing address
1662 CENTRAL AVE, ALBANY, NY 12205
(518) 452-2121
(518) 456-2865
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
042469
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
795808
UNITED CONCORDIA
NY
Enumeration date
03/21/2006
Last updated
08/24/2009
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