Provider Demographics
NPI:1114054657
Name:MANISCALCO, MICHAEL (DMD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:
Last Name:MANISCALCO
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3419 COLONNADE PKWY
Mailing Address - Street 2:SUITE 700
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35243-3374
Mailing Address - Country:US
Mailing Address - Phone:205-967-9100
Mailing Address - Fax:205-967-9609
Practice Address - Street 1:3419 COLONNADE PKWY
Practice Address - Street 2:SUITE 700
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35243-3374
Practice Address - Country:US
Practice Address - Phone:205-967-9100
Practice Address - Fax:205-967-9609
Is Sole Proprietor?:No
Enumeration Date:2007-02-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice