Healthcare Provider Details

I. General information

NPI: 1487860722
Provider Name (Legal Business Name): MANJU RANI KEJRIWAL D.D.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7140 MIAMI AVE SUITE# 102
CINCINNATI OH
45243-2676
US

IV. Provider business mailing address

7140 MIAMI AVE SUITE# 102
CINCINNATI OH
45243-2676
US

V. Phone/Fax

Practice location:
  • Phone: 513-271-5800
  • Fax: 513-271-5843
Mailing address:
  • Phone: 513-271-5800
  • Fax: 513-271-5843

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number19324
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: