MEDICARE: DR. LAUREANO E. MANALO DMD

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	DS027433L	PA

General Provider Information

NPI Number	:	1740358647
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LAUREANO E. MANALO DMD

Provider Business Mailing Address
First Line	:	1580 MCLAUGHLIN RUN ROAD, #118
Second Line	:
City	:	PITTSBURGH
State	:	PA
Zip	:	15241
Country	:	US
Telephone Number	:	412-221-2221
Fax Number	:	412-221-7290

Provider Business Practice Location Address
First Line	:	1580 MCLAUGHLIN RUN RD STE 118
Second Line	:
City	:	PITTSBURGH
State	:	PA
Zip	:	15241-3100
Country	:	US
Telephone Number	:	412-221-2221
Fax Number	:	412-221-7290

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

Provider Enumeration Date	:	12/01/2006
Last Update Date	:	10/13/2016

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