Individual
MRS. MANIJEH KHORSHIDI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.D.S.
Contact information
Practice address
1135 S CESAR E CHAVEZ DR, MILWAUKEE, WI 53204-2266
(414) 645-4540
Mailing address
640 MAC HENRY CIR # A, BROOKFIELD, WI 53045-3636
(262) 794-9118
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
3729-015
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
33695300
—
WI
Enumeration date
07/29/2006
Last updated
07/09/2007
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