Provider Demographics
NPI:1942783634
Name:MANASAN, ROSE ANN (DMD)
Entity Type:Individual
Prefix:DR
First Name:ROSE ANN
Middle Name:
Last Name:MANASAN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2409 SPORTSMAN DR
Mailing Address - Street 2:
Mailing Address - City:PHENIX CITY
Mailing Address - State:AL
Mailing Address - Zip Code:36867-5402
Mailing Address - Country:US
Mailing Address - Phone:334-297-5890
Mailing Address - Fax:334-298-2725
Practice Address - Street 1:2409 SPORTSMAN DR
Practice Address - Street 2:
Practice Address - City:PHENIX CITY
Practice Address - State:AL
Practice Address - Zip Code:36867-5402
Practice Address - Country:US
Practice Address - Phone:334-297-5890
Practice Address - Fax:334-298-2725
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-10
Last Update Date:2018-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL65771223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice