Provider Demographics
NPI:1295941524
Name:CHARLES A MANILLA D.D.S.,M,S.,INC
Entity type:Organization
Organization Name:CHARLES A MANILLA D.D.S.,M,S.,INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:513-737-6442
Mailing Address - Street 1:347 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:OH
Mailing Address - Zip Code:45013-3051
Mailing Address - Country:US
Mailing Address - Phone:513-737-6442
Mailing Address - Fax:513-737-3501
Practice Address - Street 1:347 PARK AVE
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:OH
Practice Address - Zip Code:45013-3051
Practice Address - Country:US
Practice Address - Phone:513-737-6442
Practice Address - Fax:513-737-3501
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-15
Last Update Date:2019-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH156381223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty