Provider Demographics
NPI:1467669606
Name:MANOCHA, ASHOK (BDS)
Entity Type:Individual
Prefix:
First Name:ASHOK
Middle Name:
Last Name:MANOCHA
Suffix:
Gender:M
Credentials:BDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1838 MICCOSUKEE RD
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32308-5250
Mailing Address - Country:US
Mailing Address - Phone:850-878-1345
Mailing Address - Fax:
Practice Address - Street 1:1838 MICCOSUKEE RD
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-5250
Practice Address - Country:US
Practice Address - Phone:850-878-1345
Practice Address - Fax:850-878-5496
Is Sole Proprietor?:No
Enumeration Date:2007-05-17
Last Update Date:2022-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN9380122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL072656700Medicaid