Provider Demographics
NPI:1679023865
Name:MANISHA GHOSH DDS MHA MBA INC
Entity Type:Organization
Organization Name:MANISHA GHOSH DDS MHA MBA INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:MANISHA
Authorized Official - Middle Name:
Authorized Official - Last Name:GHOSH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:669-248-5955
Mailing Address - Street 1:877 W FREMONT AVE STE A1
Mailing Address - Street 2:
Mailing Address - City:SUNNYVALE
Mailing Address - State:CA
Mailing Address - Zip Code:94087-2319
Mailing Address - Country:US
Mailing Address - Phone:669-248-5955
Mailing Address - Fax:669-248-5960
Practice Address - Street 1:877 W FREMONT AVE STE A1
Practice Address - Street 2:
Practice Address - City:SUNNYVALE
Practice Address - State:CA
Practice Address - Zip Code:94087-2319
Practice Address - Country:US
Practice Address - Phone:669-248-5955
Practice Address - Fax:669-248-5960
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-11
Last Update Date:2016-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA44682122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty