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General NPI Number Information
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NPI Number | 1568156735
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Entity Type | Individual
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Provider Name | AJITH RENGARAJAN MANIPALA DDS
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Gender | Male
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Dates
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Enumeration Date | 06/08/2023
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Last Update Date | 12/18/2025
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Provider Practice Location Address
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Address Line | 32280 FIVE MILE RD
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City | LIVONIA
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State | MI
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Zip | 48154-6112
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Country | US
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Telephone | 734-425-7010
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Fax |
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Provider Business Mailing Address
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Address Line | 4151 17 MILE RD STE F
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City | STERLING HEIGHTS
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State | MI
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Zip | 48310-6866
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Country | US
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Telephone | 586-979-3200
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Fax | 586-979-3226
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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 | 2901601769
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License Number State | MI
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