MEDICARE: DR. MANIKA PATWARI DMD, MS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	21870	MA
2	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	6360-15	WI
3	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	39811	TX

General Provider Information

NPI Number	:	1316112782
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MANIKA PATWARI DMD, MS

Provider Business Mailing Address
First Line	:	W178N9201 WATER TOWER PL STE 100
Second Line	:
City	:	MENOMONEE FALLS
State	:	WI
Zip	:	53051-8029
Country	:	US
Telephone Number	:	262-251-8704
Fax Number	:

Provider Business Practice Location Address
First Line	:	4230 AMHERST ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77005-2704
Country	:	US
Telephone Number	:	262-501-1529
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/28/2008
Last Update Date	:	07/26/2023

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