Provider Demographics
NPI:1861721367
Name:MANIAR, DIPTI U (DDS)
Entity type:Individual
Prefix:DR
First Name:DIPTI
Middle Name:U
Last Name:MANIAR
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:MRS
Other - First Name:DIPTI
Other - Middle Name:U
Other - Last Name:MANIAR
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:141 PIKE ST
Mailing Address - Street 2:
Mailing Address - City:PORT JERVIS
Mailing Address - State:NY
Mailing Address - Zip Code:12771-1807
Mailing Address - Country:US
Mailing Address - Phone:845-856-4002
Mailing Address - Fax:845-858-1127
Practice Address - Street 1:141 PIKE ST
Practice Address - Street 2:
Practice Address - City:PORT JERVIS
Practice Address - State:NY
Practice Address - Zip Code:12771-1807
Practice Address - Country:US
Practice Address - Phone:845-856-4002
Practice Address - Fax:845-858-1127
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-11
Last Update Date:2009-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY040482122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist