Provider Demographics
NPI:1114264629
Name:MANOLAKIS, JOAN-MARIE SHANAHAN (DMD)
Entity Type:Individual
Prefix:DR
First Name:JOAN-MARIE
Middle Name:SHANAHAN
Last Name:MANOLAKIS
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:508 GEORGIAN DR
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36609-3432
Mailing Address - Country:US
Mailing Address - Phone:251-342-3433
Mailing Address - Fax:251-342-3434
Practice Address - Street 1:508 GEORGIAN DR
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36609-3432
Practice Address - Country:US
Practice Address - Phone:251-342-3433
Practice Address - Fax:251-342-3434
Is Sole Proprietor?:No
Enumeration Date:2013-01-04
Last Update Date:2017-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL59571223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics