Provider Demographics
NPI:1114129509
Name:MANALASTAS, MICHAEL MAYRINA (DDS)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:MAYRINA
Last Name:MANALASTAS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2542 BERRYESSA ROAD
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95132
Mailing Address - Country:US
Mailing Address - Phone:408-926-8600
Mailing Address - Fax:408-926-8612
Practice Address - Street 1:2542 BERRYESSA ROAD
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95132
Practice Address - Country:US
Practice Address - Phone:408-926-8600
Practice Address - Fax:408-926-8612
Is Sole Proprietor?:No
Enumeration Date:2007-06-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA44025122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA6514OtherPACIFIC UNION DENTAL