Provider Demographics
NPI:1730861550
Name:MENON, AKSHAY MANOJ (DDS)
Entity type:Individual
Prefix:DR
First Name:AKSHAY MANOJ
Middle Name:
Last Name:MENON
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:404 N TEMPLE DR STE A
Mailing Address - Street 2:
Mailing Address - City:DIBOLL
Mailing Address - State:TX
Mailing Address - Zip Code:75941-1736
Mailing Address - Country:US
Mailing Address - Phone:936-526-2500
Mailing Address - Fax:
Practice Address - Street 1:404 N TEMPLE DR # A
Practice Address - Street 2:
Practice Address - City:DIBOLL
Practice Address - State:TX
Practice Address - Zip Code:75941-1736
Practice Address - Country:US
Practice Address - Phone:936-526-2500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-01
Last Update Date:2023-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX39889122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist