MEDICARE: MCMURRAY DENTAL

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	DS027484L	PA

General Provider Information

NPI Number	:	1992970420
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MCMURRAY DENTAL

Provider Business Mailing Address
First Line	:	4143 WASHINGTON RD
Second Line	:	WATERDAM CENTRE
City	:	MC MURRAY
State	:	PA
Zip	:	15317-2522
Country	:	US
Telephone Number	:	724-969-0987
Fax Number	:	724-969-1113

Provider Business Practice Location Address
First Line	:	4143 WASHINGTON RD
Second Line	:	WATERDAM CENTRE
City	:	MC MURRAY
State	:	PA
Zip	:	15317-2522
Country	:	US
Telephone Number	:	724-969-0987
Fax Number	:	724-969-1113

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. ARSENIO E MANALO
Credential	:	D.M.D.
Telephone Number	:	724-969-0987

Provider Enumeration Date	:	04/25/2008
Last Update Date	:	04/25/2008

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