Provider Demographics
NPI:1023286879
Name:KULALY, MANEEZA A (DMD)
Entity type:Individual
Prefix:DR
First Name:MANEEZA
Middle Name:A
Last Name:KULALY
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:DR
Other - First Name:MANEEZA
Other - Middle Name:N
Other - Last Name:ASKARYAR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD
Mailing Address - Street 1:18 OAK ST UNIT 657
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:94513-9998
Mailing Address - Country:US
Mailing Address - Phone:214-516-5000
Mailing Address - Fax:
Practice Address - Street 1:2931 HARBOR ST STE I
Practice Address - Street 2:
Practice Address - City:PITTSBURG
Practice Address - State:CA
Practice Address - Zip Code:94565-5464
Practice Address - Country:US
Practice Address - Phone:925-526-0000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-02-14
Last Update Date:2025-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA65261122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist