MEDICARE: ASHWINI MANJUNATHA DMD

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	DN10000920	MA

General Provider Information

NPI Number	:	1568154946
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ASHWINI MANJUNATHA DMD

Provider Business Mailing Address
First Line	:	303 THIRD ST # S719
Second Line	:
City	:	CAMBRIDGE
State	:	MA
Zip	:	02142-1156
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	9 CHANNEL CTR ST
Second Line	:
City	:	BOSTON
State	:	MA
Zip	:	02210-3428
Country	:	US
Telephone Number	:	617-268-1030
Fax Number	:

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

Provider Enumeration Date	:	05/23/2023
Last Update Date	:	11/19/2025

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