Provider Demographics
NPI:1568156735
Name:MANIPALA, AJITH RENGARAJAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:AJITH
Middle Name:RENGARAJAN
Last Name:MANIPALA
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 1:6385 B DR N
Mailing Address - Street 2:
Mailing Address - City:BATTLE CREEK
Mailing Address - State:MI
Mailing Address - Zip Code:49014-7573
Mailing Address - Country:US
Mailing Address - Phone:269-966-8700
Mailing Address - Fax:
Practice Address - Street 1:6385 B DR N
Practice Address - Street 2:
Practice Address - City:BATTLE CREEK
Practice Address - State:MI
Practice Address - Zip Code:49014-7573
Practice Address - Country:US
Practice Address - Phone:269-966-8700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-08
Last Update Date:2024-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901601769122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist