Provider Demographics
NPI:1003509522
Name:WOHLFORD, MANISHA MARIE (DDS)
Entity Type:Individual
Prefix:
First Name:MANISHA
Middle Name:MARIE
Last Name:WOHLFORD
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13828 CASTLE BROOK RD
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47725-8222
Mailing Address - Country:US
Mailing Address - Phone:812-499-2421
Mailing Address - Fax:
Practice Address - Street 1:6350 SHERIDAN BLVD STE 102
Practice Address - Street 2:
Practice Address - City:ARVADA
Practice Address - State:CO
Practice Address - Zip Code:80003-6646
Practice Address - Country:US
Practice Address - Phone:303-622-0636
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-31
Last Update Date:2023-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CODEN.00205657122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program