Provider Demographics
NPI:1710064175
Name:CHOPRA, MANISH (BDS, DMD, FADI)
Entity Type:Individual
Prefix:DR
First Name:MANISH
Middle Name:
Last Name:CHOPRA
Suffix:
Gender:M
Credentials:BDS, DMD, FADI
Other - Prefix:DR
Other - First Name:MANNY
Other - Middle Name:
Other - Last Name:CHOPRA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:BDS, DMD, FADI
Mailing Address - Street 1:110 E LOCUST ST
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:45177-2325
Mailing Address - Country:US
Mailing Address - Phone:937-382-3008
Mailing Address - Fax:937-382-7447
Practice Address - Street 1:110 E LOCUST ST
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:OH
Practice Address - Zip Code:45177-2325
Practice Address - Country:US
Practice Address - Phone:937-382-3008
Practice Address - Fax:937-382-7447
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2017-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30-02-01481223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2012584Medicaid