Provider Demographics
NPI:1073850202
Name:UPADHYAYA, MANSI P (DDS)
Entity Type:Individual
Prefix:DR
First Name:MANSI
Middle Name:P
Last Name:UPADHYAYA
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 1:1812 E LAFAYETTE PL
Mailing Address - Street 2:APT #404
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53202-1188
Mailing Address - Country:US
Mailing Address - Phone:630-212-0911
Mailing Address - Fax:
Practice Address - Street 1:5324 S 27TH ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53221-3724
Practice Address - Country:US
Practice Address - Phone:630-212-0911
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-08
Last Update Date:2016-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019.0292931223G0001X
WI7219122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice