Provider Demographics
NPI:1831975853
Name:ATWAL, MANREET
Entity type:Individual
Prefix:
First Name:MANREET
Middle Name:
Last Name:ATWAL
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 1:2605 E DATE PALM PASEO APT 3163
Mailing Address - Street 2:
Mailing Address - City:ONTARIO
Mailing Address - State:CA
Mailing Address - Zip Code:91764-4673
Mailing Address - Country:US
Mailing Address - Phone:559-679-2723
Mailing Address - Fax:
Practice Address - Street 1:2605 E DATE PALM PASEO APT 3163
Practice Address - Street 2:
Practice Address - City:ONTARIO
Practice Address - State:CA
Practice Address - Zip Code:91764-4673
Practice Address - Country:US
Practice Address - Phone:559-679-2723
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-05
Last Update Date:2023-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA29049122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist