Provider Demographics
NPI:1164602538
Name:SISODIA, MANISHA (DDS)
Entity Type:Individual
Prefix:DR
First Name:MANISHA
Middle Name:
Last Name:SISODIA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4747 N 1ST ST STE 133
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93726-0517
Mailing Address - Country:US
Mailing Address - Phone:559-226-7846
Mailing Address - Fax:
Practice Address - Street 1:4747 N 1ST ST STE 133
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93726-0517
Practice Address - Country:US
Practice Address - Phone:559-226-7846
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-14
Last Update Date:2011-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA54809122300000X, 1223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
No122300000XDental ProvidersDentist