Provider Demographics
NPI:1700077344
Name:MANI, ARCHANA (DMD)
Entity Type:Individual
Prefix:
First Name:ARCHANA
Middle Name:
Last Name:MANI
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 1:1021 BANDANA BLVD E STE 121
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55108-5128
Mailing Address - Country:US
Mailing Address - Phone:651-224-4969
Mailing Address - Fax:651-223-8047
Practice Address - Street 1:1021 BANDANA BLVD E STE 121
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55108
Practice Address - Country:US
Practice Address - Phone:651-224-4969
Practice Address - Fax:651-223-8047
Is Sole Proprietor?:No
Enumeration Date:2007-08-08
Last Update Date:2019-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNS431223P0221X
CO95071223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry