Healthcare Provider Details

I. General information

NPI: 1508125212
Provider Name (Legal Business Name): MANILA P JOSHI D.D.S
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MANILA NUCHHE PRADHAN D.D.S

II. Dates (important events)

Enumeration Date: 05/15/2012
Last Update Date: 04/10/2023
Certification Date: 04/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

EXCELSIS ROOT CANAL SPECIALTIES SUITE A-204
CLINTON MD
20734
US

IV. Provider business mailing address

9123 OLD GEORGETOWN RD
BETHESDA MD
20814
US

V. Phone/Fax

Practice location:
  • Phone: 240-244-1013
  • Fax:
Mailing address:
  • Phone: 201-835-4765
  • Fax: 301-530-0614

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number16513
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: