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General NPI Number Information
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NPI Number | 1619376787
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Entity Type | Organization
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Legal Business Name | MANUEL E.MACIAS DDS, A PROFESSIONAL CORP
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Dates
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Enumeration Date | 08/14/2014
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Last Update Date | 08/14/2014
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Provider Practice Location Address
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Address Line | 2200 W OLIVE AVE
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City | BURBANK
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State | CA
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Zip | 91506-2626
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Country | US
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Telephone | 818-846-2266
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Fax | 818-846-2539
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Provider Business Mailing Address
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Address Line | 2200 W OLIVE AVE
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City | BURBANK
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State | CA
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Zip | 91506-2626
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Country | US
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Telephone | 818-846-2266
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Fax | 818-846-2539
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MANUEL EUGENIO MACIAS
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Credential | DDS
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Telephone | 818-846-2266
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 32351
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License Number State | CA
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