Provider Demographics
NPI:1871609891
Name:KRONE, MANIVARA P (DDS)
Entity type:Individual
Prefix:
First Name:MANIVARA
Middle Name:P
Last Name:KRONE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1204 DEL MAR DR
Mailing Address - Street 2:
Mailing Address - City:SOUTHLAKE
Mailing Address - State:TX
Mailing Address - Zip Code:76092-3931
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3004 HIGHWAY 121
Practice Address - Street 2:SUITE B
Practice Address - City:BEDFORD
Practice Address - State:TX
Practice Address - Zip Code:76021-4088
Practice Address - Country:US
Practice Address - Phone:817-283-8600
Practice Address - Fax:817-283-8621
Is Sole Proprietor?:No
Enumeration Date:2006-08-22
Last Update Date:2008-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX206021223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX148216803Medicaid