Provider Demographics
NPI:1962718395
Name:BOPARAI, MANVEEN
Entity type:Individual
Prefix:
First Name:MANVEEN
Middle Name:
Last Name:BOPARAI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13441 COMMUNITY RD
Mailing Address - Street 2:
Mailing Address - City:POWAY
Mailing Address - State:CA
Mailing Address - Zip Code:92064-4723
Mailing Address - Country:US
Mailing Address - Phone:858-750-8415
Mailing Address - Fax:
Practice Address - Street 1:13441 COMMUNITY RD
Practice Address - Street 2:
Practice Address - City:POWAY
Practice Address - State:CA
Practice Address - Zip Code:92064-4723
Practice Address - Country:US
Practice Address - Phone:858-750-8415
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-23
Last Update Date:2024-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA597221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice