Provider Demographics
NPI:1891574521
Name:NICHOLAS MANIATIS DMD PLLC
Entity Type:Organization
Organization Name:NICHOLAS MANIATIS DMD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:
Authorized Official - Last Name:MANIATIS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:508-688-0749
Mailing Address - Street 1:4722 RAINIER AVE S UNIT 340
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98118-2088
Mailing Address - Country:US
Mailing Address - Phone:508-688-0749
Mailing Address - Fax:
Practice Address - Street 1:4722 RAINIER AVE S UNIT 340
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98118-2088
Practice Address - Country:US
Practice Address - Phone:508-688-0749
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-22
Last Update Date:2023-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty