Provider Demographics
NPI:1932298817
Name:CARRASCO, MANUEL C (DDS)
Entity Type:Individual
Prefix:DR
First Name:MANUEL
Middle Name:C
Last Name:CARRASCO
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7331 EAST RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:ODESSA
Mailing Address - State:TX
Mailing Address - Zip Code:79765-8903
Mailing Address - Country:US
Mailing Address - Phone:432-337-2522
Mailing Address - Fax:432-337-2755
Practice Address - Street 1:7331 EAST RIDGE RD
Practice Address - Street 2:
Practice Address - City:ODESSA
Practice Address - State:TX
Practice Address - Zip Code:79765-8903
Practice Address - Country:US
Practice Address - Phone:432-337-2522
Practice Address - Fax:432-337-2755
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2009-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX197371223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice