MEDICARE: NICHOLAS MANIATIS DMD PLLC

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

General Provider Information

NPI Number	:	1891574521
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NICHOLAS MANIATIS DMD PLLC

Provider Business Mailing Address
First Line	:	4722 RAINIER AVE S UNIT 340
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98118-2088
Country	:	US
Telephone Number	:	508-688-0749
Fax Number	:

Provider Business Practice Location Address
First Line	:	4722 RAINIER AVE S UNIT 340
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98118-2088
Country	:	US
Telephone Number	:	508-688-0749
Fax Number	:

Authorized Official
Title or Position	:	EXECUTOR
Name	:	DR. NICHOLAS MANIATIS
Credential	:	DMD
Telephone Number	:	508-688-0749

Provider Enumeration Date	:	09/22/2023
Last Update Date	:	09/22/2023

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