Individual
MEGHANA MANTHA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DMD
Contact information
Practice address
5240 FRANKLIN ST, MICHIGAN CITY, IN 46360-7372
(219) 873-9000
Mailing address
19W235 GLOUCESTER WAY N, OAK BROOK, IL 60523-1004
(703) 786-4345
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
12014455A
IN
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/15/2024
Last updated
06/09/2024
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