Provider Demographics
NPI:1114306842
Name:MANESE DENTAL INC
Entity Type:Organization
Organization Name:MANESE DENTAL INC
Other - Org Name:TRINITY DENTAL CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LIZA
Authorized Official - Middle Name:M
Authorized Official - Last Name:MANESE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:909-598-8820
Mailing Address - Street 1:19665 VALLEY BLVD
Mailing Address - Street 2:
Mailing Address - City:WALNUT
Mailing Address - State:CA
Mailing Address - Zip Code:91789-2125
Mailing Address - Country:US
Mailing Address - Phone:909-598-8820
Mailing Address - Fax:
Practice Address - Street 1:19665 VALLEY BLVD
Practice Address - Street 2:
Practice Address - City:WALNUT
Practice Address - State:CA
Practice Address - Zip Code:91789-2125
Practice Address - Country:US
Practice Address - Phone:909-598-8820
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-27
Last Update Date:2015-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA351481223G0001X
CA406691223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty