Provider Demographics
NPI:1295090165
Name:MANCHEGO, JOEL ESTEBAN (DDS)
Entity type:Individual
Prefix:DR
First Name:JOEL
Middle Name:ESTEBAN
Last Name:MANCHEGO
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 1:3770 SPRING WILLOW WAY
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27107-6053
Mailing Address - Country:US
Mailing Address - Phone:336-422-2463
Mailing Address - Fax:
Practice Address - Street 1:816 E FRANKLIN BLVD
Practice Address - Street 2:
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28054-4241
Practice Address - Country:US
Practice Address - Phone:704-396-6166
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-06
Last Update Date:2012-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC93641223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice