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NPI Code Detail

MEDICARE: JUSTIN MANEEVESE

MEDICARE:   JUSTIN  MANEEVESE
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
1390200000XStudent in an Organized Health Care Education/Training Program
21223G0001XGeneral Practice Dentistry32850TX

General Provider Information

NPI Number : 1588047104
Entity Type Code : Individual
Provider Name (Legal Business Name) : JUSTIN MANEEVESE
Provider Business Mailing Address
First Line : 5430 SPANISH OAK DR
Second Line :
City : HOUSTON
State : TX
Zip : 77066-2823
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 5430 SPANISH OAK DR
Second Line :
City : HOUSTON
State : TX
Zip : 77066-2823
Country : US
Telephone Number : 713-518-2973
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/30/2015
Last Update Date : 11/15/2017

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