Provider Demographics
NPI:1336627579
Name:MANIKKATH, APARNA
Entity Type:Individual
Prefix:
First Name:APARNA
Middle Name:
Last Name:MANIKKATH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:470 CLEMENTINA ST UNIT 203
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94103-4162
Mailing Address - Country:US
Mailing Address - Phone:415-774-6449
Mailing Address - Fax:
Practice Address - Street 1:470 CLEMENTINA ST UNIT 203
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94103-4162
Practice Address - Country:US
Practice Address - Phone:415-774-6449
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-31
Last Update Date:2018-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA102820122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist