Provider Demographics
NPI:1215000971
Name:MANOGARAN, NANDA K (DDS)
Entity Type:Individual
Prefix:
First Name:NANDA
Middle Name:K
Last Name:MANOGARAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16410 TWIN LAKES AVE STE J107
Mailing Address - Street 2:
Mailing Address - City:MARYSVILLE
Mailing Address - State:WA
Mailing Address - Zip Code:98271-4727
Mailing Address - Country:US
Mailing Address - Phone:360-652-0800
Mailing Address - Fax:360-652-0844
Practice Address - Street 1:16410 TWIN LAKES AVE STE J107
Practice Address - Street 2:
Practice Address - City:MARYSVILLE
Practice Address - State:WA
Practice Address - Zip Code:98271-4727
Practice Address - Country:US
Practice Address - Phone:360-652-0800
Practice Address - Fax:360-652-0844
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-17
Last Update Date:2017-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE000088671223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice