Provider Demographics
NPI:1669752861
Name:MANARANG, MARIA VICTORIA (RDH)
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:VICTORIA
Last Name:MANARANG
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:MARIA
Other - Middle Name:VICTORIA
Other - Last Name:ARIAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1544 SE LARCH WAY
Mailing Address - Street 2:
Mailing Address - City:GRESHAM
Mailing Address - State:OR
Mailing Address - Zip Code:97080-2986
Mailing Address - Country:US
Mailing Address - Phone:503-666-4209
Mailing Address - Fax:
Practice Address - Street 1:600 NE 8TH ST
Practice Address - Street 2:
Practice Address - City:GRESHAM
Practice Address - State:OR
Practice Address - Zip Code:97030-7317
Practice Address - Country:US
Practice Address - Phone:503-988-4900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-19
Last Update Date:2011-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORH6088124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist