Individual
DR. DHIVYALAKSHMI MANAVAZHAGAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
6215 E STATE ST, ROCKFORD, IL 61108-2514
(815) 399-7080
Mailing address
6215 E STATE ST, ROCKFORD, IL 61108-2514
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
2901602316
MI
1223G0001X
General Practice Dentistry
Primary
019.035499
IL
Other
Enumeration date
09/30/2024
Last updated
11/18/2024
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