Provider Demographics
NPI:1164195475
Name:MANASSRA, AHMED (DMD)
Entity Type:Individual
Prefix:DR
First Name:AHMED
Middle Name:
Last Name:MANASSRA
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1102 S ABEL ST APT 332
Mailing Address - Street 2:
Mailing Address - City:MILPITAS
Mailing Address - State:CA
Mailing Address - Zip Code:95035-9043
Mailing Address - Country:US
Mailing Address - Phone:408-913-5946
Mailing Address - Fax:
Practice Address - Street 1:1102 S ABEL ST APT 332
Practice Address - Street 2:
Practice Address - City:MILPITAS
Practice Address - State:CA
Practice Address - Zip Code:95035-9043
Practice Address - Country:US
Practice Address - Phone:408-913-5946
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-01
Last Update Date:2021-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1067541223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice