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General NPI Number Information
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NPI Number | 1184302788
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Entity Type | Individual
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Provider Name | KUNAL LALIT MANSUKHANI DMD
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Gender | Male
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Dates
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Enumeration Date | 07/05/2023
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Last Update Date | 07/05/2023
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Provider Practice Location Address
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Address Line | 2790 NE 106TH AVE STE A
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City | HILLSBORO
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State | OR
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Zip | 97124-7449
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Country | US
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Telephone | 503-844-0700
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Fax |
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Provider Business Mailing Address
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Address Line | 2222 NW RALEIGH ST APT 630
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City | PORTLAND
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State | OR
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Zip | 97210-3921
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Country | US
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Telephone | 602-300-0370
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | D11829
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License Number State | OR
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