Healthcare Provider Details

I. General information

NPI: 1932013596
Provider Name (Legal Business Name): MANALI DIVYESH VORA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/30/2026
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 FRANKLIN TOWN BLVD APT 616
PHILADELPHIA PA
19103-1243
US

IV. Provider business mailing address

1 FRANKLIN TOWN BLVD APT 616
PHILADELPHIA PA
19103-1243
US

V. Phone/Fax

Practice location:
  • Phone: 949-771-5755
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDS045742
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: