Provider Demographics
NPI:1639285679
Name:MANANZAN, SHEREE (DDS)
Entity Type:Individual
Prefix:DR
First Name:SHEREE
Middle Name:
Last Name:MANANZAN
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 1:31 HARMONY RD
Mailing Address - Street 2:
Mailing Address - City:SPRING VALLEY
Mailing Address - State:NY
Mailing Address - Zip Code:10977-2326
Mailing Address - Country:US
Mailing Address - Phone:917-566-3979
Mailing Address - Fax:
Practice Address - Street 1:175 ROUTE 59
Practice Address - Street 2:DENTAL DEPT.
Practice Address - City:SPRING VALLEY
Practice Address - State:NY
Practice Address - Zip Code:10977-5231
Practice Address - Country:US
Practice Address - Phone:917-566-3979
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-22
Last Update Date:2009-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0523181223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice