Provider Demographics
NPI:1043689466
Name:MANOHAR, SRIJANANI (DMD)
Entity Type:Individual
Prefix:DR
First Name:SRIJANANI
Middle Name:
Last Name:MANOHAR
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 1:895 MORAGA RD STE 1
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:CA
Mailing Address - Zip Code:94549-5046
Mailing Address - Country:US
Mailing Address - Phone:925-283-5454
Mailing Address - Fax:
Practice Address - Street 1:895 MORAGA RD STE 1
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:CA
Practice Address - Zip Code:94549-5046
Practice Address - Country:US
Practice Address - Phone:925-283-5454
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-15
Last Update Date:2023-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA648601223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice