Dhivyalakshmi Manavazhagan, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

019.035499 Issued in IL

Practice address

6215 E State St
Rockford, IL 61108-2514

Phone

(815) 399-7080

NPI assigned

Sep 30, 2024

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1727654400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1731888000000",
    "number": "1386462216",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6215 E STATE ST",
            "city": "ROCKFORD",
            "state": "IL",
            "postal_code": "611082514"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6215 E STATE ST",
            "city": "ROCKFORD",
            "state": "IL",
            "postal_code": "611082514",
            "telephone_number": "815-399-7080"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1011 N University Ave",
            "address_purpose": "LOCATION",
            "city": "Ann Arbor",
            "state": "MI",
            "postal_code": "481091078",
            "country_code": "US",
            "telephone_number": "734-763-6933",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MANAVAZHAGAN",
        "first_name": "DHIVYALAKSHMI",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-09-30",
        "last_updated": "2024-11-18",
        "certification_date": "2024-11-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "MI",
            "license": "2901602316",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "IL",
            "license": "019.035499",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Genevieve Maltby, LCSW
• Courtnea D Malugen, N.P.
• Pushpa K Mamtani, MD
• Joel M. Manaligod, M.D.
• Arturo Santiago Manas, M.D.
• Krishna K R Manda, MD
• Kris James Manders
• Manish Prajwal Mane Manohar, M.D.
• Roxana Koren Manger, APN
• Manhattan Dental Associates PC

• General Practice Dentistry in Rockford, IL
• Providers in Rockford, IL by specialty
• General Practice Dentistry in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 18, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.