Provider Demographics
NPI:1205022662
Name:MARY ROSE B. MANZANA DDS INC
Entity Type:Organization
Organization Name:MARY ROSE B. MANZANA DDS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MARY ROSE
Authorized Official - Middle Name:B
Authorized Official - Last Name:MANZANA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:661-714-1361
Mailing Address - Street 1:24307 ASTOR RACING CT
Mailing Address - Street 2:
Mailing Address - City:VALENCIA
Mailing Address - State:CA
Mailing Address - Zip Code:91354-4918
Mailing Address - Country:US
Mailing Address - Phone:661-714-1361
Mailing Address - Fax:661-294-5018
Practice Address - Street 1:24307 ASTOR RACING CT
Practice Address - Street 2:
Practice Address - City:VALENCIA
Practice Address - State:CA
Practice Address - Zip Code:91354-4918
Practice Address - Country:US
Practice Address - Phone:661-714-1361
Practice Address - Fax:661-294-5018
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-19
Last Update Date:2007-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty