=====================================================
General NPI Number Information
=====================================================
NPI Number | 1508782186
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MARLENE BARRALES MANNING DDS
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/26/2026
-----------------------------------------------------
Last Update Date | 06/26/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 201 N RIVERSIDE AVE # E2
-----------------------------------------------------
City | SAINT CLAIR
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48079-5491
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 810-329-2289
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 45628 ALTZ ST
-----------------------------------------------------
City | UTICA
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48315-5940
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | 2901603186
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------