DR. MANEESH MOHAN (NPI# 1154310985) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1154310985 |
| Entity Type | Individual |
| Full Name | DR. MANEESH MOHAN |
| Credential | DMD |
| Practice Address |
5100 Outer Loop Suite B Louisville KY 40219-3201 |
| Mailing Address |
2441 State St New Albany IN 47150-4962 |
| Practice Telephone | 5029668660 |
| Practice Fax Number | 5029698444 |
| Mailing Telephone | 8129447200 |
| Mailing Fax Number | 8129453260 |
| Enumeration Date | 2005-10-14 |
| Last Update Date | 2014-06-12 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 1223S0112X |
Dentist Specialization: Oral and Maxillofacial Surgery |
12011030A | IN | Dental Providers |
| Y | 1223S0112X |
Dentist Specialization: Oral and Maxillofacial Surgery |
8191 | KY | Dental Providers |
| N | 204E00000X | Oral & Maxillofacial Surgery | 8181 | KY | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| IN | 200872180 | 05 | |
| KY | 204E0000X | 05 | |
| KY | PASSPORT | 50007575 | 01 |
| KY | 6411381400 | 05 | |
| KY | DORAL | 9179239 | 01 |
| Street Address |
5100 OUTER LOOP SUITE B |
| City | LOUISVILLE |
| State | KY |
| Zip Code | 40219-3201 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1891799847 | Elizabeth Rouse Wong | Family Medicine | 5100 Outer Loop, Louisville, KY 40219-4056 | 2005-06-08 |
| 1528438124 | Mina Bear | Nurse Practitioner | 5100 Outer Loop, Louisville, KY 40219-4056 | 2015-09-25 |
| 1639585441 | Wanda Lea Schlaug | Nurse Practitioner | 5100 Outer Loop, Louisville, KY 40219-4056 | 2014-07-01 |
| 1467891382 | Marcelo Enrique Venegas | Nurse Practitioner | 5100 Outer Loop, Louisville, KY 40219-3023 | 2013-06-25 |
| 1053756502 | Alexander Musser | Dentist | 5100 Outer Loop, Louisville, KY 40219 | 2013-05-09 |
| 1578853982 | Periodontic & Endodontic Services-jefferson Mall, Pllc | Clinic/Center | 5100 Outer Loop, Ste B, Louisville, KY 40219-4056 | 2011-04-19 |
| 1851620504 | Nancy L Wilding | Registered Nurse | 5100 Outer Loop, Louisville, KY 40219-4056 | 2009-12-09 |
| 1639357502 | Kids Dentistry-jefferson Mall,pllc | Clinic/Center | 5100 Outer Loop, Suite C, Louisville, KY 40219-4056 | 2008-02-04 |
| 1033397914 | Specialized Dental Services-jefferson Mall, Pllc | Dentist | 5100 Outer Loop, Suite B, Louisville, KY 40219-4056 | 2008-02-04 |
| 1174653471 | Charla Jaynette Froman Glover | Nurse Practitioner | 5100 Outer Loop, Louisville, KY 40219-4056 | 2007-03-06 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1255948154 | Kathleen B Berghausen | Nurse Practitioner | 4112 Fern Valley Rod, Louisville, KY 40219 | 2020-09-25 |
| 1174165989 | Joann Deborah Hobbs | Nurse Practitioner | 8216 Delido Rd, Louisville, KY 40219 | 2019-10-14 |
| 1962989319 | Jennifer Lynn Pinkerton | Hearing Instrument Specialist | 7326 Preston Hwy, Suite 206a, Louisville, KY 40219 | 2018-07-27 |
| 1942748447 | Melissa Freeman Emanuele | Speech-Language Pathologist | 1550 Raydale Drive, Lousville, KY 40219 | 2017-02-03 |
| 1083014013 | Christopher Maxey | Specialist/Technologist | Fern Valley Rd, Louisville, KY 40219 | 2014-08-27 |
| 1679985949 | Antwan Turner | Case Manager/Care Coordinator | 5523 Saxon Blvd, Louisville, KY 40219 | 2014-05-21 |
| 1386055168 | Kelly Larson | Case Manager/Care Coordinator | 6809 Bebe Ct., Louisville, KY 40219 | 2014-05-14 |
| 1639414626 | Prettysmilesdenturesandmorellc | Dentist | 19123 West Mcnichols Rd, Detroit, MI 40219 | 2012-12-03 |
| 1881967701 | Vickie Lynn Dixon | Homemaker | 3516 Templewood Dr., Louisville, KY 40219 | 2012-02-23 |
| 1811157555 | Tonya Lynn Frost | Chiropractor | 4300 Outer Loop Ste 10, Louisville, KY 40219 | 2008-06-16 |
| Find all providers in zip 40219 | ||||
| Taxonomy Code | 1223S0112X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | Oral and Maxillofacial Surgery |
| The specialty of dentistry which includes the diagnosis, surgical and adjunctive treatment of diseases, injuries and defects involving both the functional and esthetic aspects of the hard and soft tissues of the oral and maxillofacial region. |
| Notes: Source: Council on Dental Education and Licensure, American Dental Association |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1023510518 | Ralph M. Green Medical Pllc | Dentist | 3809 Poplar Level Rd Ste B, Louisville, KY 40213-1429 | 2018-03-01 |
| 1922361062 | Alan Reisman, Dds, PC | Dentist | 1075 S Boulder Rd Ste 135, Louisville, CO 80027-2559 | 2012-06-22 |
| 1245481175 | Joseph H. Cieslak Dds, Pllc | Dentist | 6501 Dixie Hwy, Louisville, KY 40258-3907 | 2008-10-09 |
| 1033372057 | Lawrence Sivori II | Dentist | 3101 Breckenridge Ln Ste 2d, Louisville, KY 40220-2742 | 2008-07-09 |
| 1790944106 | David Naselsker | Dentist | 3421 Hycliffe Ave, Louisville, KY 40207-3659 | 2008-06-02 |
| 1235329400 | Thad R. Schulten Psc | Dentist | 4515 Churchman Ave., Louisville, KY 40215 | 2007-07-25 |
| 1730382722 | Lewis C. Jones | Dentist | 401 E Chestnut St Unit 550, Louisville, KY 40202-5705 | 2007-06-07 |
| 1104982016 | Mark D. Miller | Dentist | 1211 W Broadway Unit 106, Louisville, KY 40203-2082 | 2006-12-28 |
| 1285709865 | David T Dodd | Dentist | 4122 Shelbyville Rd Ste 120, Louisville, KY 40207-3206 | 2006-11-21 |
| 1306933387 | Alan Jon Reisman | Dentist | 1075 E South Boulder Rd, Suite 230, Louisville, CO 80027-2560 | 2006-10-09 |
| Find all providers in LOUISVILLE | ||||
| City | LOUISVILLE |
| Zip Code | 40219 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.