MEDICARE: DR. CHELSEA MANISCALCO 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	122300000X	Dentist	6407	AL

General Provider Information

NPI Number	:	1851821961
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHELSEA MANISCALCO DMD

Provider Business Mailing Address
First Line	:	2901 CENTRAL AVE
Second Line	:
City	:	BIRMINGHAM
State	:	AL
Zip	:	35209-2505
Country	:	US
Telephone Number	:	205-870-1363
Fax Number	:

Provider Business Practice Location Address
First Line	:	2901 CENTRAL AVE
Second Line	:
City	:	BIRMINGHAM
State	:	AL
Zip	:	35209-2505
Country	:	US
Telephone Number	:	205-870-1363
Fax Number	:

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

Provider Enumeration Date	:	06/13/2017
Last Update Date	:	03/28/2022

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