Provider Demographics
NPI:1104020999
Name:MATHUR, MANJIRI BHATE (DMD)
Entity Type:Individual
Prefix:DR
First Name:MANJIRI
Middle Name:BHATE
Last Name:MATHUR
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 1:207 OMNI DR
Mailing Address - Street 2:
Mailing Address - City:HILLSBOROUGH
Mailing Address - State:NJ
Mailing Address - Zip Code:08844-4525
Mailing Address - Country:US
Mailing Address - Phone:908-292-8050
Mailing Address - Fax:
Practice Address - Street 1:207 OMNI DR
Practice Address - Street 2:
Practice Address - City:HILLSBOROUGH
Practice Address - State:NJ
Practice Address - Zip Code:08844-4525
Practice Address - Country:US
Practice Address - Phone:908-292-8050
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-13
Last Update Date:2012-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22675001223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics