MEDICARE: MANSKE DENTAL CORPORATION

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	261QD0000X	Dental Clinic/Center	59357	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1801280383
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MANSKE DENTAL CORPORATION

Provider Business Mailing Address
First Line	:	1355 N SIERRA BONITA AVE APT 302
Second Line	:
City	:	WEST HOLLYWOOD
State	:	CA
Zip	:	90046-8518
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	:	424-322-4781

Authorized Official
Title or Position	:	CEO
Name	:	DR. JESSICA LYNN MANSKE
Credential	:	DDS
Telephone Number	:	424-354-9336

Provider Enumeration Date	:	03/24/2015
Last Update Date	:	08/02/2024

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Directions to “MANSKE DENTAL CORPORATION ” Practice Location

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