Provider Demographics
NPI:1316966500
Name:MANJI, MEHMOOD FATEHALI (DDS)
Entity type:Individual
Prefix:DR
First Name:MEHMOOD
Middle Name:FATEHALI
Last Name:MANJI
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 1:8009 PASEO ARRAYAN
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92009-6962
Mailing Address - Country:US
Mailing Address - Phone:310-210-3000
Mailing Address - Fax:
Practice Address - Street 1:7733 PALM ST
Practice Address - Street 2:SUITE 105
Practice Address - City:LEMON GROVE
Practice Address - State:CA
Practice Address - Zip Code:91945-2952
Practice Address - Country:US
Practice Address - Phone:619-464-7099
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA461091223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice