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General NPI Number Information
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NPI Number | 1891574521
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Entity Type | Organization
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Legal Business Name | NICHOLAS MANIATIS DMD PLLC
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Dates
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Enumeration Date | 09/22/2023
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Last Update Date | 09/22/2023
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Provider Practice Location Address
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Address Line | 4722 RAINIER AVE S UNIT 340
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City | SEATTLE
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State | WA
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Zip | 98118-2088
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Country | US
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Telephone | 508-688-0749
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Fax |
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Provider Business Mailing Address
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Address Line | 4722 RAINIER AVE S UNIT 340
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City | SEATTLE
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State | WA
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Zip | 98118-2088
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Country | US
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Telephone | 508-688-0749
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Fax |
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Authorized Official
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Title or Position | EXECUTOR
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Name | DR. NICHOLAS MANIATIS
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Credential | DMD
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Telephone | 508-688-0749
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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 |
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License Number State |
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