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NPI Code Detail

MEDICARE: KAHLEA ELIZABETH MANCARUSO RDH

MEDICARE: KAHLEA ELIZABETH MANCARUSO RDH
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
1124Q00000XDental Hygienist

General Provider Information

NPI Number : 1376483438
Entity Type Code : Individual
Provider Name (Legal Business Name) : KAHLEA ELIZABETH MANCARUSO RDH
Provider Business Mailing Address
First Line : 3519 E CHATTAROY RD
Second Line :
City : CHATTAROY
State : WA
Zip : 99003-8615
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 6601 W THOMAS RD
Second Line :
City : PHOENIX
State : AZ
Zip : 85033-5700
Country : US
Telephone Number : 602-243-7277
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/30/2026
Last Update Date : 03/30/2026

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Directions to “ KAHLEA ELIZABETH MANCARUSO RDH” Practice Location

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