Provider Demographics
NPI:1053036202
Name:MANZUR, NISHAT N (DMD)
Entity type:Individual
Prefix:DR
First Name:NISHAT
Middle Name:N
Last Name:MANZUR
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1595 BRIAR OAK DR
Mailing Address - Street 2:
Mailing Address - City:ROYAL PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33411-6145
Mailing Address - Country:US
Mailing Address - Phone:786-899-8588
Mailing Address - Fax:
Practice Address - Street 1:1595 BRIAR OAK DR
Practice Address - Street 2:
Practice Address - City:ROYAL PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33411-6145
Practice Address - Country:US
Practice Address - Phone:786-899-8588
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-10
Last Update Date:2022-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA108182122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist