Provider Demographics
NPI:1114137940
Name:BOTCHWAY-MANU, SHIRLEY (DMD)
Entity Type:Individual
Prefix:DR
First Name:SHIRLEY
Middle Name:
Last Name:BOTCHWAY-MANU
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 1:470 PROSPECT AVE
Mailing Address - Street 2:SUITE 301
Mailing Address - City:WEST ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07052-4153
Mailing Address - Country:US
Mailing Address - Phone:973-324-0660
Mailing Address - Fax:973-324-0180
Practice Address - Street 1:470 PROSPECT AVE
Practice Address - Street 2:SUITE 301
Practice Address - City:WEST ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07052-4153
Practice Address - Country:US
Practice Address - Phone:973-324-0660
Practice Address - Fax:973-324-0180
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJDI 189791223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice