Individual
DR. MANEESH MOHAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
5100 OUTER LOOP, SUITE B, LOUISVILLE, KY 40219-3201
(502) 966-8660
(502) 969-8444
Mailing address
2441 STATE ST, NEW ALBANY, IN 47150-4962
(812) 944-7200
(812) 945-3260
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
12011030A
IN
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
8191
KY
204E00000X
Oral & Maxillofacial Surgery (D.M.D.)
8181
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200872180
—
IN
05
—
204E0000X
—
KY
01
—
50007575
PASSPORT
KY
05
—
6411381400
—
KY
01
—
9179239
DORAL
KY
Enumeration date
10/14/2005
Last updated
06/12/2014
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