Provider Demographics
NPI:1780337915
Name:BADGUJAR, MANJARI CHINTAN (DDS)
Entity type:Individual
Prefix:DR
First Name:MANJARI
Middle Name:CHINTAN
Last Name:BADGUJAR
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1037 CESAR E CHAVEZ DR
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53204
Mailing Address - Country:US
Mailing Address - Phone:414-999-3666
Mailing Address - Fax:414-999-3667
Practice Address - Street 1:1037 S CESAR E CHAVEZ DR
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53204-2204
Practice Address - Country:US
Practice Address - Phone:414-989-3666
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-28
Last Update Date:2024-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1002746-15122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist