Provider Demographics
NPI:1124125398
Name:BATH, MANRAJ S (DMD)
Entity type:Individual
Prefix:DR
First Name:MANRAJ
Middle Name:S
Last Name:BATH
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1575 CROSS CREEKS BLVD
Mailing Address - Street 2:
Mailing Address - City:PICKERINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:43147-8237
Mailing Address - Country:US
Mailing Address - Phone:614-751-7500
Mailing Address - Fax:614-322-7900
Practice Address - Street 1:1575 CROSS CREEKS BLVD
Practice Address - Street 2:
Practice Address - City:PICKERINGTON
Practice Address - State:OH
Practice Address - Zip Code:43147-8237
Practice Address - Country:US
Practice Address - Phone:614-751-7500
Practice Address - Fax:614-322-7900
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2013-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH201621223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000358014OtherANTHEM BCBS PIN NUMBER