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General NPI Number Information
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NPI Number | 1467999433
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Entity Type | Organization
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Legal Business Name | MCMANUS
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Dates
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Enumeration Date | 01/27/2017
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Last Update Date | 01/27/2017
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Provider Practice Location Address
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Address Line | 2334 31ST AVE
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City | ROCK ISLAND
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State | IL
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Zip | 61201-6248
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Country | US
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Telephone | 309-558-0075
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Fax |
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Provider Business Mailing Address
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Address Line | 2804 24TH ST UNIT #1
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City | ROCK ISLAND
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State | IL
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Zip | 61201-5360
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Country | US
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Telephone | 563-210-4531
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Fax |
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Authorized Official
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Title or Position | OWNER/ORTHODONTIST
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Name | DR. MICHELLE MARIE MCMANUS
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Credential | D.D.S., M.S.
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Telephone | 563-210-4531
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number |
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License Number State |
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