Healthcare Provider Details

I. General information

NPI: 1831547645
Provider Name (Legal Business Name): MATTHEW MANIOUS D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2016
Last Update Date: 03/13/2025
Certification Date: 03/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 WYOMING ST MIAMI VALLEY HOSPITAL PREMIER HEALTH
DAYTON OH
45409-2722
US

IV. Provider business mailing address

5S465 ALLISON LN
NAPERVILLE IL
60540-3800
US

V. Phone/Fax

Practice location:
  • Phone: 937-208-3851
  • Fax:
Mailing address:
  • Phone: 630-355-3700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number019031126
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: