Provider Demographics
NPI:1689939878
Name:MILANI, MANDANA BASTANI (DMD)
Entity type:Individual
Prefix:MRS
First Name:MANDANA
Middle Name:BASTANI
Last Name:MILANI
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8994 TOUR DR STE 220
Mailing Address - Street 2:
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75070-2036
Mailing Address - Country:US
Mailing Address - Phone:214-304-1199
Mailing Address - Fax:469-301-3216
Practice Address - Street 1:8994 TOUR DR STE 220
Practice Address - Street 2:
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75070-2036
Practice Address - Country:US
Practice Address - Phone:214-304-1199
Practice Address - Fax:469-301-3216
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-12
Last Update Date:2020-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX28669122300000X
IN12011853A122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist