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General NPI Number Information
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NPI Number | 1316957442
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Entity Type | Individual
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Provider Name | MARC MANANGAN SERRA DDS, FACS
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Gender | Male
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Dates
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Enumeration Date | 08/09/2006
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Last Update Date | 04/05/2023
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Provider Practice Location Address
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Address Line | MADIGAN ARMY MEDICAL CENTER 9040 JACKSON AVE
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City | TACOMA
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State | WA
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Zip | 98431-0001
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Country | US
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Telephone | 253-968-0178
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Fax |
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Provider Business Mailing Address
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Address Line | 3010 NARROWS PL
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City | TACOMA
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State | WA
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Zip | 98407-1058
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Country | US
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Telephone |
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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 | 171000000X
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Taxonomy Name | Military Health Care Provider
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | DE 60272622
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License Number State | WA
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