Provider Demographics
NPI:1316112782
Name:PATWARI, MANIKA (DMD, MS)
Entity type:Individual
Prefix:DR
First Name:MANIKA
Middle Name:
Last Name:PATWARI
Suffix:
Gender:F
Credentials:DMD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:W178N9201 WATER TOWER PL STE 100
Mailing Address - Street 2:
Mailing Address - City:MENOMONEE FALLS
Mailing Address - State:WI
Mailing Address - Zip Code:53051-8029
Mailing Address - Country:US
Mailing Address - Phone:262-251-8704
Mailing Address - Fax:
Practice Address - Street 1:4230 AMHERST ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77005-2704
Practice Address - Country:US
Practice Address - Phone:262-501-1529
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-28
Last Update Date:2023-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA218701223G0001X
WI6360-151223X0400X
TX398111223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
No1223G0001XDental ProvidersDentistGeneral Practice