MEDICARE: DR. CONNIE M. MANUEL D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	7740	WA

General Provider Information

NPI Number	:	1033262803
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CONNIE M. MANUEL D.D.S.

Provider Business Mailing Address
First Line	:	2445 65TH PL SE
Second Line	:
City	:	MERCER ISLAND
State	:	WA
Zip	:	98040-2503
Country	:	US
Telephone Number	:	206-232-3135
Fax Number	:	206-232-2734

Provider Business Practice Location Address
First Line	:	6725 GREENWOOD AVE N
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98103-5225
Country	:	US
Telephone Number	:	206-284-2483
Fax Number	:	206-784-4511

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/18/2007
Last Update Date	:	07/08/2007

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