MEDICARE: JONAH ALEXANDER MANALO DMD

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	DS045763	PA

General Provider Information

NPI Number	:	1639003379
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JONAH ALEXANDER MANALO DMD

Provider Business Mailing Address
First Line	:	4143 WASHINGTON RD
Second Line	:
City	:	CANONSBURG
State	:	PA
Zip	:	15317-2522
Country	:	US
Telephone Number	:	724-969-0987
Fax Number	:

Provider Business Practice Location Address
First Line	:	4143 WASHINGTON RD
Second Line	:
City	:	CANONSBURG
State	:	PA
Zip	:	15317-2522
Country	:	US
Telephone Number	:	724-969-0987
Fax Number	:

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

Provider Enumeration Date	:	06/09/2026
Last Update Date	:	06/09/2026

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