Active NPI
Manisha Brahma
- Dentist
- Minneapolis, MN
National Provider Identifier
1588916852
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- D12337
- Practice address
- 2120 Nicollet Ave
Minneapolis, MN 55404-2528 - Phone
- (612) 412-3641
- NPI assigned
- Oct 10, 2012
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | D12337 | MN | Primary |
Addresses
Primary practice location
2120 Nicollet Ave
Minneapolis, MN 55404-2528
Mailing address
2120 Nicollet Ave
Minneapolis, MN 55404-2528
Phone (612) 412-3641
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1558525204 | Medicaid | MN | |
| 1366483802 | Medicaid | MN |
Other names 1
- Manisha Malhotra
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| D12337 | MN | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1349827200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1365465600000",
"number": "1588916852",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2120 NICOLLET AVE",
"city": "MINNEAPOLIS",
"state": "MN",
"postal_code": "554042528",
"telephone_number": "612-412-3641",
"fax_number": "612-412-3641"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2120 NICOLLET AVE",
"city": "MINNEAPOLIS",
"state": "MN",
"postal_code": "554042528",
"telephone_number": "612-412-3641"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BRAHMA",
"first_name": "MANISHA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2012-10-10",
"last_updated": "2013-04-09",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "MN",
"license": "D12337",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1558525204",
"state": "MN"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1366483802",
"state": "MN"
}
],
"endpoints": [],
"other_names": [
{
"first_name": "MANISHA",
"last_name": "MALHOTRA",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Minneapolis, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 9, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.