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General NPI Number Information
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NPI Number | 1235447335
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Entity Type | Organization
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Legal Business Name | MANALESE DENTAL CORPORATION
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Dates
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Enumeration Date | 09/23/2010
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Last Update Date | 06/26/2015
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Provider Practice Location Address
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Address Line | 626 S 2ND AVE
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City | COVINA
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State | CA
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Zip | 91723-3517
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Country | US
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Telephone | 626-332-0013
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Fax | 626-332-0431
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Provider Business Mailing Address
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Address Line | 626 S 2ND AVE
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City | COVINA
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State | CA
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Zip | 91723-3517
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Country | US
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Telephone | 626-332-0013
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Fax | 626-332-0431
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Authorized Official
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Title or Position | OWNER
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Name | DR. JOSE JOEL MANALESE
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Credential | DDS
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Telephone | 626-332-0013
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 58729
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License Number State | CA
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