Provider Demographics
NPI:1548212509
Name:MANI, MELISSA E (DDS)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:E
Last Name:MANI
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 1:1452 S LA BRUCHERIE RD
Mailing Address - Street 2:STE B
Mailing Address - City:EL CENTRO
Mailing Address - State:CA
Mailing Address - Zip Code:92243-9676
Mailing Address - Country:US
Mailing Address - Phone:760-482-5505
Mailing Address - Fax:760-482-5501
Practice Address - Street 1:1502 S LA BRUCHERIE RD
Practice Address - Street 2:
Practice Address - City:EL CENTRO
Practice Address - State:CA
Practice Address - Zip Code:92243-9676
Practice Address - Country:US
Practice Address - Phone:760-482-5505
Practice Address - Fax:760-482-5501
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA37992122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB37992OtherHEALTHY FAMILIES PROG
CAD37992Medicaid