Healthcare Provider Details

I. General information

NPI: 1972423721
Provider Name (Legal Business Name): SARITA MANNAN DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2026
Last Update Date: 07/20/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3645 NORTHGATE BOULEVARD SACRAMENTO, CALIFORNIA 95834
SACRAMENTO CA
95834
US

IV. Provider business mailing address

1345 HARVEST GLEN WAY
SACRAMENTO CA
95834-1671
US

V. Phone/Fax

Practice location:
  • Phone: 916-576-1403
  • Fax:
Mailing address:
  • Phone: 404-668-9178
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number113280
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: