Healthcare Provider Details

I. General information

NPI: 1497458459
Provider Name (Legal Business Name): JYOTHSNA MANCHIKALAPUDI D.D.S
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2023
Last Update Date: 09/16/2025
Certification Date: 09/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

180 N DEAN ST STE 1
ENGLEWOOD NJ
07631-2534
US

IV. Provider business mailing address

2356 BERKSHIRE LN
NORTH BRUNSWICK NJ
08902-4906
US

V. Phone/Fax

Practice location:
  • Phone: 201-569-5437
  • Fax:
Mailing address:
  • Phone: 224-424-9015
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number22DI03068700
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number07557
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: