MEDICARE: LAURA MANUEL DDS, INC

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	46493	CA

General Provider Information

NPI Number	:	1225239395
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LAURA MANUEL DDS, INC

Provider Business Mailing Address
First Line	:	5580 E 2ND ST STE 201
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90803-3959
Country	:	US
Telephone Number	:	562-433-6735
Fax Number	:

Provider Business Practice Location Address
First Line	:	5580 E 2ND ST STE 201
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90803-3959
Country	:	US
Telephone Number	:	562-433-6735
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	LAURA MANUEL
Credential	:	DDS
Telephone Number	:	562-433-6735

Provider Enumeration Date	:	05/29/2007
Last Update Date	:	07/10/2007

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