Provider Demographics
NPI:1558944561
Name:MANCHANDA, KANIKA (DDS)
Entity type:Individual
Prefix:
First Name:KANIKA
Middle Name:
Last Name:MANCHANDA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:58 SILO RIDGE RD S
Mailing Address - Street 2:
Mailing Address - City:ORLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60467-7380
Mailing Address - Country:US
Mailing Address - Phone:708-949-1282
Mailing Address - Fax:
Practice Address - Street 1:6132 W CREEK RD
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:OH
Practice Address - Zip Code:44131-2130
Practice Address - Country:US
Practice Address - Phone:216-524-8481
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-28
Last Update Date:2024-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30026605122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1922005743OtherDENTAL OFFICE NPI