# MANOJ K BAHL, DDS, PC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Excel Dental Studio
- **Organization subpart:** No

## Provider details

- **NPI number:** 1295118172
- **Authorized official:** DR. MANOJ K BAHL DDS, PC (OWNER/DENTIST)
- **Authorized official phone:** (219) 769-3305

## Contact information

- **Practice address:** 40 W 73RD AVE, MERRILLVILLE, IN 46410-3979
- **Practice address phone:** (219) 769-3305
- **Practice address fax:** (219) 769-4674
- **Mailing address:** 40 W 73RD AVE, MERRILLVILLE, IN 46410-3979
- **Mailing address phone:** (219) 769-3305
- **Mailing address fax:** (219) 769-4674

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | 12011727A | IN | Yes |

## Other

- **Enumeration date:** 07/09/2015
- **Last updated:** 09/16/2015

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 201300110A | — | IN |