Provider Demographics
NPI:1164104865
Name:MANCHANDA, JANICA
Entity Type:Individual
Prefix:DR
First Name:JANICA
Middle Name:
Last Name:MANCHANDA
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 1:33777 N SCOTTSDALE RD STE 105
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85266-1569
Mailing Address - Country:US
Mailing Address - Phone:480-488-4884
Mailing Address - Fax:
Practice Address - Street 1:33777 N SCOTTSDALE RD STE 105
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85266-1569
Practice Address - Country:US
Practice Address - Phone:480-488-4884
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-02
Last Update Date:2023-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD011328122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist