Healthcare Provider Details

I. General information

NPI: 1902531759
Provider Name (Legal Business Name): MANISH ANAND BDS,MDS,DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/17/2022
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3101 OAK GROVE RD STE 6
POPLAR BLUFF MO
63901-8916
US

IV. Provider business mailing address

939 QUINCY SHORE DR
QUINCY MA
02170-3532
US

V. Phone/Fax

Practice location:
  • Phone: 573-840-3013
  • Fax:
Mailing address:
  • Phone: 617-515-6815
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberDL15215
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number2026042533
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: