MEDICARE: JERALD E. MCMANIGAL, DDS, PC

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	1223G0001X	General Practice Dentistry	6752	NE

General Provider Information

NPI Number	:	1588176887
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JERALD E. MCMANIGAL, DDS, PC

Provider Business Mailing Address
First Line	:	13518 W CENTER RD
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68144-3408
Country	:	US
Telephone Number	:	402-905-2950
Fax Number	:

Provider Business Practice Location Address
First Line	:	13518 W CENTER RD
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68144-3408
Country	:	US
Telephone Number	:	402-905-2950
Fax Number	:	402-905-2950

Authorized Official
Title or Position	:	OWNER/DENTIST
Name	:	DR. JERALD EUGENE MCMANIGAL
Credential	:	DDS
Telephone Number	:	402-905-2950

Provider Enumeration Date	:	10/27/2017
Last Update Date	:	10/27/2017

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