Healthcare Provider Details

I. General information

NPI: 1821218298
Provider Name (Legal Business Name): MANISHA HARISH RAMCHANDANI DENTIST
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/26/2007
Last Update Date: 09/05/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12157 VICTORY BLVD
NORTH HOLLYWOOD CA
91606-3204
US

IV. Provider business mailing address

3232 SAWTELLE BLVD APT 107
LOS ANGELES CA
90066-1616
US

V. Phone/Fax

Practice location:
  • Phone: 818-755-8000
  • Fax: 818-755-8006
Mailing address:
  • Phone: 818-755-8000
  • Fax: 818-755-8006

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number53478
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: