Provider Demographics
NPI:1386835155
Name:MARIA ELENA MANZOR DDS, P.C.
Entity type:Organization
Organization Name:MARIA ELENA MANZOR DDS, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:ELENA
Authorized Official - Last Name:MANZOR
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:586-751-3950
Mailing Address - Street 1:28633 HOOVER RD
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48093-4105
Mailing Address - Country:US
Mailing Address - Phone:586-751-3950
Mailing Address - Fax:586-751-3992
Practice Address - Street 1:28633 HOOVER RD
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48093-4105
Practice Address - Country:US
Practice Address - Phone:586-751-3950
Practice Address - Fax:586-751-3992
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-07
Last Update Date:2007-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty