Provider Demographics
NPI:1104178821
Name:ATWAL, MANVEEN K
Entity Type:Individual
Prefix:DR
First Name:MANVEEN
Middle Name:K
Last Name:ATWAL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8534 SW 68TH RD
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32608-5696
Mailing Address - Country:US
Mailing Address - Phone:337-852-5581
Mailing Address - Fax:
Practice Address - Street 1:3731 NW 40TH TER
Practice Address - Street 2:SUITE A
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32606-8148
Practice Address - Country:US
Practice Address - Phone:352-376-3099
Practice Address - Fax:352-376-6366
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-04
Last Update Date:2012-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN199791223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice