Provider Demographics
NPI:1235447335
Name:MANALESE DENTAL CORPORATION
Entity Type:Organization
Organization Name:MANALESE DENTAL CORPORATION
Other - Org Name:MANALESE DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:JOEL
Authorized Official - Last Name:MANALESE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:626-332-0013
Mailing Address - Street 1:626 S 2ND AVE
Mailing Address - Street 2:
Mailing Address - City:COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91723-3517
Mailing Address - Country:US
Mailing Address - Phone:626-332-0013
Mailing Address - Fax:626-332-0431
Practice Address - Street 1:626 S 2ND AVE
Practice Address - Street 2:
Practice Address - City:COVINA
Practice Address - State:CA
Practice Address - Zip Code:91723-3517
Practice Address - Country:US
Practice Address - Phone:626-332-0013
Practice Address - Fax:626-332-0431
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-23
Last Update Date:2015-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA587291223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty