Healthcare Provider Details

I. General information

NPI: 1508782186
Provider Name (Legal Business Name): MARLENE BARRALES MANNING DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/26/2026
Last Update Date: 06/26/2026
Certification Date: 06/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 N RIVERSIDE AVE # E2
SAINT CLAIR MI
48079-5491
US

IV. Provider business mailing address

45628 ALTZ ST
UTICA MI
48315-5940
US

V. Phone/Fax

Practice location:
  • Phone: 810-329-2289
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number2901603186
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: