Provider Demographics
NPI:1568710655
Name:MANRAJ S. BATH, DDS, INC.
Entity Type:Organization
Organization Name:MANRAJ S. BATH, DDS, INC.
Other - Org Name:PICKERINGTON MANOR JAW & FACIAL SURGERY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ORAL & MAXILLOFACIAL SURGEON
Authorized Official - Prefix:DR
Authorized Official - First Name:MANRAJ
Authorized Official - Middle Name:S
Authorized Official - Last Name:BATH
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:614-751-7500
Mailing Address - Street 1:1575 CROSS CREEKS BLVD
Mailing Address - Street 2:
Mailing Address - City:PICKERINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:43147
Mailing Address - Country:US
Mailing Address - Phone:614-751-7500
Mailing Address - Fax:614-322-7900
Practice Address - Street 1:1575 CROSS CREEKS BLVD.
Practice Address - Street 2:
Practice Address - City:PICKERINGTON
Practice Address - State:OH
Practice Address - Zip Code:43147
Practice Address - Country:US
Practice Address - Phone:614-751-7500
Practice Address - Fax:614-322-7900
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-21
Last Update Date:2016-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH201621223S0112X, 204E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial SurgeryGroup - Multi-Specialty
No1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Multi-Specialty