Provider Demographics
NPI:1396850541
Name:MANZO, MICHAEL J (DMD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:J
Last Name:MANZO
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:805 MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:SHARPSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15215-2209
Mailing Address - Country:US
Mailing Address - Phone:412-781-0313
Mailing Address - Fax:
Practice Address - Street 1:805 MAIN STREET
Practice Address - Street 2:
Practice Address - City:SHARPSBURG
Practice Address - State:PA
Practice Address - Zip Code:15215-2209
Practice Address - Country:US
Practice Address - Phone:412-781-0313
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS019254L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice