Provider Demographics
NPI:1235638099
Name:MANHIANI DENTAL LLC
Entity Type:Organization
Organization Name:MANHIANI DENTAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MANINDER
Authorized Official - Middle Name:MARLINA
Authorized Official - Last Name:MANHIANI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:706-564-5497
Mailing Address - Street 1:3830 WASHINGTON RD STE 9
Mailing Address - Street 2:
Mailing Address - City:MARTINEZ
Mailing Address - State:GA
Mailing Address - Zip Code:30907-5070
Mailing Address - Country:US
Mailing Address - Phone:706-564-5497
Mailing Address - Fax:
Practice Address - Street 1:3830 WASHINGTON RD STE 9
Practice Address - Street 2:
Practice Address - City:MARTINEZ
Practice Address - State:GA
Practice Address - Zip Code:30907-5070
Practice Address - Country:US
Practice Address - Phone:706-564-5497
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-07
Last Update Date:2018-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN015526122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty