Provider Demographics
NPI:1841742756
Name:PRADHAN, MANISHA SHRESTHA (DMD)
Entity Type:Individual
Prefix:
First Name:MANISHA
Middle Name:SHRESTHA
Last Name:PRADHAN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:608 MERGANSER TRL
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:MS
Mailing Address - Zip Code:39056-6258
Mailing Address - Country:US
Mailing Address - Phone:601-415-9319
Mailing Address - Fax:
Practice Address - Street 1:105 RIDGEWAY
Practice Address - Street 2:
Practice Address - City:FLOWOOD
Practice Address - State:MS
Practice Address - Zip Code:39232
Practice Address - Country:US
Practice Address - Phone:601-415-9319
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-26
Last Update Date:2016-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS3895-16122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist