Provider Demographics
NPI:1285856104
Name:MANESE, LIZA M (DMD)
Entity Type:Individual
Prefix:DR
First Name:LIZA
Middle Name:M
Last Name:MANESE
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 1:19665 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:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-02
Last Update Date:2010-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA351481223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB35148-01OtherDENTICAL(CA.MEDICAL PROG)