Provider Demographics
NPI:1053924126
Name:MANKOTIA PLLC
Entity type:Organization
Organization Name:MANKOTIA PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SAURABH
Authorized Official - Middle Name:
Authorized Official - Last Name:MANKOTIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:409-299-4014
Mailing Address - Street 1:6408 I-45 GULF FWY
Mailing Address - Street 2:STE B
Mailing Address - City:LA MARQUE
Mailing Address - State:TX
Mailing Address - Zip Code:77568-3091
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6408 I-45 GULF FWY STE B
Practice Address - Street 2:
Practice Address - City:LA MARQUE
Practice Address - State:TX
Practice Address - Zip Code:77568-3091
Practice Address - Country:US
Practice Address - Phone:409-299-4014
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-28
Last Update Date:2024-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
No261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDentalGroup - Single Specialty