Provider Demographics
NPI:1740358647
Name:MANALO, LAUREANO E (DMD)
Entity type:Individual
Prefix:DR
First Name:LAUREANO
Middle Name:E
Last Name:MANALO
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:DR
Other - First Name:LARRY
Other - Middle Name:E
Other - Last Name:MANALO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DMD
Mailing Address - Street 1:1580 MCLAUGHLIN RUN ROAD, #118
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15241
Mailing Address - Country:US
Mailing Address - Phone:412-221-2221
Mailing Address - Fax:412-221-7290
Practice Address - Street 1:1580 MCLAUGHLIN RUN RD STE 118
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15241-3100
Practice Address - Country:US
Practice Address - Phone:412-221-2221
Practice Address - Fax:412-221-7290
Is Sole Proprietor?:No
Enumeration Date:2006-12-01
Last Update Date:2016-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS027433L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice