Provider Demographics
NPI:1447379714
Name:MANKAD, SHRUTI U (DMD)
Entity Type:Individual
Prefix:DR
First Name:SHRUTI
Middle Name:U
Last Name:MANKAD
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:415 BOSTON TURNPIKE RD
Mailing Address - Street 2:SUIT # 103
Mailing Address - City:SHREWSBURY
Mailing Address - State:MA
Mailing Address - Zip Code:01545-3446
Mailing Address - Country:US
Mailing Address - Phone:508-925-5738
Mailing Address - Fax:
Practice Address - Street 1:415 BOSTON TURNPIKE RD
Practice Address - Street 2:SUIT # 103
Practice Address - City:SHREWSBURY
Practice Address - State:MA
Practice Address - Zip Code:01545-3446
Practice Address - Country:US
Practice Address - Phone:508-925-5738
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-28
Last Update Date:2010-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA206841223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice