Provider Demographics
NPI:1114575453
Name:MANJU R KEJRIWAL DDS INC
Entity Type:Organization
Organization Name:MANJU R KEJRIWAL DDS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:MANJU
Authorized Official - Middle Name:R
Authorized Official - Last Name:KEJRIWAL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:513-271-5800
Mailing Address - Street 1:7140 MIAMI AVE STE 102
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45243-2676
Mailing Address - Country:US
Mailing Address - Phone:513-271-5800
Mailing Address - Fax:513-271-5843
Practice Address - Street 1:7140 MIAMI AVE STE 102
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45243-2676
Practice Address - Country:US
Practice Address - Phone:513-271-5800
Practice Address - Fax:513-271-5843
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-29
Last Update Date:2019-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0106920Medicaid