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General NPI Number Information
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NPI Number | 1659333854
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Entity Type | Individual
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Provider Name | MANUEL MARIEN JR. DDS
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Gender | Male
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Dates
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Enumeration Date | 04/04/2006
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Last Update Date | 04/14/2015
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Provider Practice Location Address
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Address Line | 4431 68TH STREET HQ, USA DENTAC
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City | FORT HOOD
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State | TX
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Zip | 76544
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Country | US
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Telephone | 254-287-2705
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Fax | 254-287-1786
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Provider Business Mailing Address
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Address Line | 4431 68TH STREET HQS, USA DENTAC
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City | FT HOOD
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State | TX
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Zip | 76544-5054
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Country | US
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Telephone | 254-287-2705
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Fax | 254-287-1786
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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 | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 20830
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License Number State | TX
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