Provider Demographics
NPI:1871669549
Name:NEJADI, MANA K (DMD)
Entity type:Individual
Prefix:DR
First Name:MANA
Middle Name:K
Last Name:NEJADI
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8001 ROOSEVELT BLVD
Mailing Address - Street 2:SUITE# 503, SMYLIE TIMES BUILDING
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19152-3038
Mailing Address - Country:US
Mailing Address - Phone:215-268-9655
Mailing Address - Fax:215-338-1979
Practice Address - Street 1:8001 ROOSEVELT BLVD
Practice Address - Street 2:SUITE# 503, SMYLIE TIMES BUILDING
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19152-3038
Practice Address - Country:US
Practice Address - Phone:215-268-9655
Practice Address - Fax:215-338-1979
Is Sole Proprietor?:No
Enumeration Date:2006-11-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS 0363301223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA101704159Medicaid
PA101704159Medicare ID - Type Unspecified