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General NPI Number Information
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NPI Number | 1710442348
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Entity Type | Organization
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Legal Business Name | SRIJNANI MANOHAR DMD INC
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Dates
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Enumeration Date | 02/07/2019
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Last Update Date | 10/19/2023
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Provider Practice Location Address
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Address Line | 895 MORAGA RD STE 1
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City | LAFAYETTE
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State | CA
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Zip | 94549-5046
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Country | US
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Telephone | 925-283-5454
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Fax |
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Provider Business Mailing Address
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Address Line | 895 MORAGA RD STE 1
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City | LAFAYETTE
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State | CA
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Zip | 94549-5046
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Country | US
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Telephone | 925-283-5454
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | DR. SRIJANANI MANOHAR
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Credential | DMD
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Telephone | 707-623-7477
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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