Provider Demographics
NPI:1821432709
Name:AMANDA MCMANUS
Entity Type:Organization
Organization Name:AMANDA MCMANUS
Other - Org Name:MCMANUS ORTHODONTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SOLE PROPIETOR
Authorized Official - Prefix:DR
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:MCMANUS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:860-324-7870
Mailing Address - Street 1:3 OAK ST
Mailing Address - Street 2:
Mailing Address - City:SHREWSBURY
Mailing Address - State:MA
Mailing Address - Zip Code:01545-2713
Mailing Address - Country:US
Mailing Address - Phone:508-842-8908
Mailing Address - Fax:
Practice Address - Street 1:3 OAK ST
Practice Address - Street 2:
Practice Address - City:SHREWSBURY
Practice Address - State:MA
Practice Address - Zip Code:01545-2713
Practice Address - Country:US
Practice Address - Phone:508-842-8908
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-23
Last Update Date:2013-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN18556201223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA9903972Medicaid