=====================================================
General NPI Number Information
=====================================================
NPI Number | 1225915796
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SARI R. MANAP DENTAL, PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/18/2025
-----------------------------------------------------
Last Update Date | 09/11/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1901 LAC DE VILLE BLVD
-----------------------------------------------------
City | ROCHESTER
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 14618-5660
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 585-461-1200
-----------------------------------------------------
Fax | 585-461-3851
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1901 LAC DE VILLE BLVD
-----------------------------------------------------
City | ROCHESTER
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 14618-5660
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 585-461-1200
-----------------------------------------------------
Fax | 585-461-3851
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. SARI RATNA MANAP
-----------------------------------------------------
Credential | DDS
-----------------------------------------------------
Telephone | 585-461-1200
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223P0221X
-----------------------------------------------------
Taxonomy Name | Pediatric Dentistry
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------