Provider Demographics
NPI:1730665910
Name:VASAVADA, MANASI G (DDS)
Entity Type:Individual
Prefix:
First Name:MANASI
Middle Name:G
Last Name:VASAVADA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3011 GATEWAY DR APT 302
Mailing Address - Street 2:
Mailing Address - City:SUFFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23435-1143
Mailing Address - Country:US
Mailing Address - Phone:734-239-5711
Mailing Address - Fax:
Practice Address - Street 1:5900 E VIRGINIA BEACH BLVD
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23502-2530
Practice Address - Country:US
Practice Address - Phone:757-978-2177
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-11
Last Update Date:2020-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ2DI02723400122300000X
VA04014171301223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist