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General NPI Number Information
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NPI Number | 1295213254
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Entity Type | Individual
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Provider Name | ALDRENE MANASAN DMD
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Gender | Male
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Dates
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Enumeration Date | 08/01/2018
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Last Update Date | 07/01/2024
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Provider Practice Location Address
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Address Line | 228 E HOSPITAL RD BLDG 320
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City | FORT EISENHOWER
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State | GA
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Zip | 30905-6011
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Country | US
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Telephone | 706-787-5102
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Fax |
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Provider Business Mailing Address
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Address Line | 2110 SYLVAN LAKE DR
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City | GROVETOWN
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State | GA
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Zip | 30813-5852
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Country | US
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Telephone | 706-787-5102
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number | DDS102593
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DDS102593
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DDS102593
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License Number State | CA
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