Provider Demographics
NPI:1316253669
Name:BHANDARI, MANRAJ (DDS)
Entity type:Individual
Prefix:DR
First Name:MANRAJ
Middle Name:
Last Name:BHANDARI
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1395 WILLOW BUD DR
Mailing Address - Street 2:
Mailing Address - City:WALNUT
Mailing Address - State:CA
Mailing Address - Zip Code:91789-3889
Mailing Address - Country:US
Mailing Address - Phone:909-576-4555
Mailing Address - Fax:
Practice Address - Street 1:1395 WILLOW BUD DR
Practice Address - Street 2:
Practice Address - City:WALNUT
Practice Address - State:CA
Practice Address - Zip Code:91789-3889
Practice Address - Country:US
Practice Address - Phone:909-576-4555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-25
Last Update Date:2010-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0552101223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice