MEDICARE: DR. GEORGE MANOLARAKIS DDS

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	122300000X	Dentist	0458511	NY

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	:	1831175140
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GEORGE MANOLARAKIS DDS

Provider Business Mailing Address
First Line	:	7 HIGH ST
Second Line	:	STE 209
City	:	HUNTINGTON
State	:	NY
Zip	:	11743-3417
Country	:	US
Telephone Number	:	631-673-8061
Fax Number	:	631-427-7350

Provider Business Practice Location Address
First Line	:	7 HIGH ST
Second Line	:	STE 209
City	:	HUNTINGTON
State	:	NY
Zip	:	11743-7605
Country	:	US
Telephone Number	:	631-673-8061
Fax Number	:	631-427-7350

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

Provider Enumeration Date	:	12/19/2005
Last Update Date	:	07/08/2007

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