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NPI Code Detail

MEDICARE: DR. RENALIE MANUEL DDS

MEDICARE: DR. RENALIE MANUEL DDS
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
11223G0001XGeneral Practice Dentistry55087CA
21223G0001XGeneral Practice Dentistry5176NV
31223P0221XPediatric Dentistry5176NV
41223P0221XPediatric DentistryS6-108NV

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1902952070
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. RENALIE MANUEL DDS
Provider Business Mailing Address
First Line : 526 S TONOPAH DR
Second Line : STE. 200
City : LAS VEGAS
State : NV
Zip : 89106-4043
Country : US
Telephone Number : 702-291-2031
Fax Number : 702-366-1483
Provider Business Practice Location Address
First Line : 169 N NELLIS BLVD
Second Line :
City : LAS VEGAS
State : NV
Zip : 89110-5320
Country : US
Telephone Number : 702-384-1010
Fax Number : 702-438-8424
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/25/2007
Last Update Date : 06/27/2016

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Directions to “ DR. RENALIE MANUEL DDS” Practice Location

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