Provider Demographics
NPI:1417264177
Name:MANANGKIL, ROCHELLE ACOBA (DDS)
Entity Type:Individual
Prefix:DR
First Name:ROCHELLE
Middle Name:ACOBA
Last Name:MANANGKIL
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3417 BROADWAY ST STE J1
Mailing Address - Street 2:
Mailing Address - City:AMERICAN CANYON
Mailing Address - State:CA
Mailing Address - Zip Code:94503-1262
Mailing Address - Country:US
Mailing Address - Phone:707-346-2400
Mailing Address - Fax:707-346-2401
Practice Address - Street 1:3417 BROADWAY ST.
Practice Address - Street 2:STE J-1
Practice Address - City:AMERICAN CANYON
Practice Address - State:CA
Practice Address - Zip Code:94503-1262
Practice Address - Country:US
Practice Address - Phone:707-346-2400
Practice Address - Fax:707-346-2401
Is Sole Proprietor?:No
Enumeration Date:2010-09-01
Last Update Date:2021-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA596691223G0001X
CO102651223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice