Provider Demographics
NPI:1417047267
Name:NATARAJAN, MANJULA (DDS)
Entity Type:Individual
Prefix:
First Name:MANJULA
Middle Name:
Last Name:NATARAJAN
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 1:2727 FAIRFIELD COMMONS BLVD
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45431-3778
Mailing Address - Country:US
Mailing Address - Phone:937-431-0947
Mailing Address - Fax:937-431-0950
Practice Address - Street 1:2727 FAIRFIELD COMMONS BLVD
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45431-3778
Practice Address - Country:US
Practice Address - Phone:937-431-0947
Practice Address - Fax:937-431-0950
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH219791223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2518949Medicaid