Provider Demographics
NPI:1811031057
Name:MANZANA, MARY ROSE BICIERRO (DDS)
Entity Type:Individual
Prefix:
First Name:MARY ROSE
Middle Name:BICIERRO
Last Name:MANZANA
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 1:24307 ASTOR RACING CT
Mailing Address - Street 2:
Mailing Address - City:VALENCIA
Mailing Address - State:CA
Mailing Address - Zip Code:91354-4918
Mailing Address - Country:US
Mailing Address - Phone:661-714-1361
Mailing Address - Fax:661-294-5018
Practice Address - Street 1:24307 ASTOR RACING CT
Practice Address - Street 2:
Practice Address - City:VALENCIA
Practice Address - State:CA
Practice Address - Zip Code:91354-4918
Practice Address - Country:US
Practice Address - Phone:661-714-1361
Practice Address - Fax:661-294-5018
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-19
Last Update Date:2024-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA45917122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist