Provider Demographics
NPI:1043796600
Name:MANN, AJAYPAL SINGH
Entity type:Individual
Prefix:
First Name:AJAYPAL
Middle Name:SINGH
Last Name:MANN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:507 CHERRY LN
Mailing Address - Street 2:
Mailing Address - City:ROBERTS
Mailing Address - State:WI
Mailing Address - Zip Code:54023-9731
Mailing Address - Country:US
Mailing Address - Phone:262-836-4225
Mailing Address - Fax:715-600-9025
Practice Address - Street 1:507 CHERRY LN
Practice Address - Street 2:
Practice Address - City:ROBERTS
Practice Address - State:WI
Practice Address - Zip Code:54023-9731
Practice Address - Country:US
Practice Address - Phone:262-836-4225
Practice Address - Fax:715-600-9025
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-17
Last Update Date:2024-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1002676-151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice