Provider Demographics
NPI:1871875203
Name:D'AMELIO, MANIJEH JENNY (MANIJEH D'AMELIO)
Entity type:Individual
Prefix:DR
First Name:MANIJEH
Middle Name:JENNY
Last Name:D'AMELIO
Suffix:
Gender:F
Credentials:MANIJEH D'AMELIO
Other - Prefix:DR
Other - First Name:M.
Other - Middle Name:JENNY
Other - Last Name:D'AMELIO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:M JENNY D'AMELIO
Mailing Address - Street 1:12420 TIMBERLAND BLVD STE 416
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76244-5230
Mailing Address - Country:US
Mailing Address - Phone:817-799-5948
Mailing Address - Fax:
Practice Address - Street 1:12420 TIMBERLAND BLVD STE 416
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76244-5230
Practice Address - Country:US
Practice Address - Phone:817-799-5948
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-12
Last Update Date:2024-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX40249122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty