Healthcare Provider Details

I. General information

NPI: 1093190662
Provider Name (Legal Business Name): UDAY B MANCHALA DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/24/2015
Last Update Date: 09/08/2025
Certification Date: 09/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

850 LAKELAND DR
CHIPPEWA FALLS WI
54729-1687
US

IV. Provider business mailing address

850 LAKELAND DRIVE FAMILY HEALTH CENTER OF MARSHFIELD
CHIPPEWA FALLS WI
54729
US

V. Phone/Fax

Practice location:
  • Phone: 715-738-2000
  • Fax:
Mailing address:
  • Phone: 715-738-2000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number1001183-15
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: