Provider Demographics
NPI:1811406465
Name:JUNEJA, MANISH (DMD)
Entity Type:Individual
Prefix:DR
First Name:MANISH
Middle Name:
Last Name:JUNEJA
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26 WORCESTER ST APT 403
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02118-3377
Mailing Address - Country:US
Mailing Address - Phone:857-770-8044
Mailing Address - Fax:
Practice Address - Street 1:9 GROVE ST
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:MA
Practice Address - Zip Code:01364-1009
Practice Address - Country:US
Practice Address - Phone:978-544-3515
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-27
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN1857755122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist