Individual
DR. CYNTHIA ANN MANDERS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
D.D.S.
Contact information
Practice address
115 N DIXIE DR, SUITE 310, LAKE JACKSON, TX 77566-5903
(979) 297-2308
(979) 297-3737
Mailing address
115 N DIXIE DR, SUITE 310, LAKE JACKSON, TX 77566-5903
(979) 297-2308
(979) 297-3737
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
15346
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1208175-01
—
TX
01
—
736506
TRICARE DENTAL PROGRAM
TX
01
—
76-0337233
CIGNA
TX
01
—
D-15346
BCBS OF TEXAS
TX
Enumeration date
03/14/2007
Last updated
07/08/2007
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