Healthcare Provider Details

I. General information

NPI: 1316957442
Provider Name (Legal Business Name): MARC MANANGAN SERRA DDS, FACS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2006
Last Update Date: 04/05/2023
Certification Date: 04/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

MADIGAN ARMY MEDICAL CENTER 9040 JACKSON AVE
TACOMA WA
98431-0001
US

IV. Provider business mailing address

3010 NARROWS PL
TACOMA WA
98407-1058
US

V. Phone/Fax

Practice location:
  • Phone: 253-968-0178
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberDE 60272622
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: