Provider Demographics
NPI:1134282064
Name:MACIAS, MANUEL EUGENIO (DDS)
Entity Type:Individual
Prefix:DR
First Name:MANUEL
Middle Name:EUGENIO
Last Name:MACIAS
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 1:2200 W OLIVE AVE
Mailing Address - Street 2:
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91506-2626
Mailing Address - Country:US
Mailing Address - Phone:818-846-2266
Mailing Address - Fax:818-846-2539
Practice Address - Street 1:2200 W OLIVE AVE
Practice Address - Street 2:
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91506-2626
Practice Address - Country:US
Practice Address - Phone:818-846-2266
Practice Address - Fax:818-846-2539
Is Sole Proprietor?:No
Enumeration Date:2006-12-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA32351122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist