Provider Demographics
NPI:1841414067
Name:DAVINDER S. MANAK DDS. INCORPORATION
Entity Type:Organization
Organization Name:DAVINDER S. MANAK DDS. INCORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:DAVINDER
Authorized Official - Middle Name:SINGH
Authorized Official - Last Name:MANAK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:209-460-1223
Mailing Address - Street 1:1334 S CENTER ST
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95206-1331
Mailing Address - Country:US
Mailing Address - Phone:209-460-1223
Mailing Address - Fax:209-460-1370
Practice Address - Street 1:1334 S CENTER ST
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95206-1331
Practice Address - Country:US
Practice Address - Phone:209-460-1223
Practice Address - Fax:209-460-1370
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA413101223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG92783-01OtherDENTICAL PROVIDE