Provider Demographics
NPI:1811062169
Name:MAGGAN, MANOJ (DDS, DAAPM, FICCMO)
Entity type:Individual
Prefix:DR
First Name:MANOJ
Middle Name:
Last Name:MAGGAN
Suffix:
Gender:M
Credentials:DDS, DAAPM, FICCMO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3590 OLD MILTON PKWY
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30005-4465
Mailing Address - Country:US
Mailing Address - Phone:770-521-1978
Mailing Address - Fax:
Practice Address - Street 1:3590 OLD MILTON PKWY
Practice Address - Street 2:
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30005-4465
Practice Address - Country:US
Practice Address - Phone:770-521-1978
Practice Address - Fax:770-521-9936
Is Sole Proprietor?:No
Enumeration Date:2006-11-22
Last Update Date:2009-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA11376122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist