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General NPI Number Information
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NPI Number | 1952491177
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Entity Type | Organization
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Legal Business Name | ROBERT J MANZANARES DDS PC
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Dates
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Enumeration Date | 10/16/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 232 PASEO DE ONATE
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City | ESPANOLA
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State | NM
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Zip | 87532
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Country | US
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Telephone | 505-753-7246
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Fax | 505-753-4359
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Provider Business Mailing Address
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Address Line | 232 PASEO DE ONATE
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City | ESPANOLA
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State | NM
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Zip | 87532
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Country | US
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Telephone | 505-753-7246
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Fax | 505-753-4359
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MS. NANCY J MANZANARES
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Credential |
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Telephone | 505-753-7246
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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 | 1358
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License Number State | NM
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