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General NPI Number Information
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NPI Number | 1568956308
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Entity Type | Individual
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Provider Name | RONEN MANOSOV DDS
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Gender | Male
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Dates
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Enumeration Date | 06/15/2018
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Last Update Date | 06/15/2018
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Provider Practice Location Address
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Address Line | 4646 EL CAMINO REAL
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City | LOS ALTOS
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State | CA
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Zip | 94022-1329
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Country | US
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Telephone | 650-383-5599
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Fax |
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Provider Business Mailing Address
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Address Line | 773 HAVERHILL DR
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City | SUNNYVALE
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State | CA
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Zip | 94087-1232
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Country | US
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Telephone | 408-242-5010
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 102529
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License Number State | CA
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