MEDICARE: DR. JESSICA LYNN MANSKE D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	59357	CA
2	1223P0221X	Pediatric Dentistry	59357	CA

General Provider Information

NPI Number	:	1083926323
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JESSICA LYNN MANSKE D.D.S.

Provider Business Mailing Address
First Line	:	1355 N SIERRA BONITA
Second Line	:	#302
City	:	WEST HOLLYWOOD
State	:	CA
Zip	:	90046
Country	:	US
Telephone Number	:	424-354-9336
Fax Number	:	424-322-4781

Provider Business Practice Location Address
First Line	:	445 N ALFRED ST
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90048-2504
Country	:	US
Telephone Number	:	424-354-9336
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/01/2010
Last Update Date	:	08/02/2024

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