| Doctor Name: | DR. JASON GERARD MANDELARIS |
| NPI Number: | 1811144785 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | D.M.D. |
| License Number: | 7579613-9922 |
| Business Practice Address: | 275 W 200 N 175 Lindon, UT - 840425009 |
| Business Phone Number: | 8017692530 |
| Business Fax Number: | |
| Mailing Address: | 275 W 200 N, 175 LINDON |
| State: | UT |
| Postal Code: | 840425009 |
| Phone Number: | 8017692530 |
| Fax Number: | |
| NPI Enumeration Date: | 08/22/2008 |
| NPI Last Update Date: | 07/12/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 1223P0221X |
| License Number: | 7579613-9922 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | UT |
| Taxonomy Type: | Dental Providers |
| Taxonomy Classification: | Dentist |
| Taxonomy Specialization: | Pediatric Dentistry |
| Taxonomy Definition: | An age-defined specialty that provides both primary and comprehensive preventive and therapeutic oral health care for infants and children through adolescence, including those with special health care needs. |