Provider Demographics
NPI:1659404929
Name:THAKRAR, MANSUKHLAL JIVANDAS (DDS)
Entity Type:Individual
Prefix:DR
First Name:MANSUKHLAL
Middle Name:JIVANDAS
Last Name:THAKRAR
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:MANU
Other - Middle Name:JIVANDAS
Other - Last Name:THAKRAR
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:124 FAIRPORT VILLAGE LNDG
Mailing Address - Street 2:
Mailing Address - City:FAIRPORT
Mailing Address - State:NY
Mailing Address - Zip Code:14450-1804
Mailing Address - Country:US
Mailing Address - Phone:585-223-5480
Mailing Address - Fax:
Practice Address - Street 1:124 FAIRPORT VILLAGE LNDG
Practice Address - Street 2:
Practice Address - City:FAIRPORT
Practice Address - State:NY
Practice Address - Zip Code:14450-1804
Practice Address - Country:US
Practice Address - Phone:585-223-5480
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0369741223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry