Provider Demographics
NPI:1518212455
Name:MOHAN, MANIK (DDS)
Entity Type:Individual
Prefix:DR
First Name:MANIK
Middle Name:
Last Name:MOHAN
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 1:721 NORWICH RD
Mailing Address - Street 2:
Mailing Address - City:PLAINFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06374-1734
Mailing Address - Country:US
Mailing Address - Phone:860-546-4222
Mailing Address - Fax:860-546-4223
Practice Address - Street 1:721 NORWICH RD
Practice Address - Street 2:
Practice Address - City:PLAINFIELD
Practice Address - State:CT
Practice Address - Zip Code:06374-1734
Practice Address - Country:US
Practice Address - Phone:860-546-4222
Practice Address - Fax:860-546-4223
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-17
Last Update Date:2016-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT110551223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice