Provider Demographics
NPI:1093190662
Name:MANCHALA, UDAY B (DDS)
Entity Type:Individual
Prefix:
First Name:UDAY
Middle Name:B
Last Name:MANCHALA
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:850 LAKELAND DRIVE
Mailing Address - Street 2:FAMILY HEALTH CENTER OF MARSHFIELD
Mailing Address - City:CHIPPEWA FALLS
Mailing Address - State:WI
Mailing Address - Zip Code:54729
Mailing Address - Country:US
Mailing Address - Phone:715-738-2000
Mailing Address - Fax:
Practice Address - Street 1:850 LAKELAND DRIVE
Practice Address - Street 2:FAMILY HEALTH CENTER OF MARSHFIELD
Practice Address - City:CHIPPEWA FALLS
Practice Address - State:WI
Practice Address - Zip Code:54729
Practice Address - Country:US
Practice Address - Phone:715-738-2000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-24
Last Update Date:2023-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1001183-15122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist