Healthcare Provider Details

I. General information

NPI: 1487708558
Provider Name (Legal Business Name): MANUEL TJOA DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/23/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 W MOANA LN STE 7
RENO NV
89509-4959
US

IV. Provider business mailing address

3170 CREEKWOOD DR
RENO NV
89502-7725
US

V. Phone/Fax

Practice location:
  • Phone: 775-826-2244
  • Fax:
Mailing address:
  • Phone: 775-826-2244
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number2689
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: