Provider Demographics
NPI:1104084557
Name:MANAOIS, TEODOR (DDS)
Entity type:Individual
Prefix:
First Name:TEODOR
Middle Name:
Last Name:MANAOIS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2645 OCEAN AVE
Mailing Address - Street 2:SUITE 210
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94132-1633
Mailing Address - Country:US
Mailing Address - Phone:415-587-4700
Mailing Address - Fax:415-587-8145
Practice Address - Street 1:2645 OCEAN AVE
Practice Address - Street 2:SUITE 210
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94132-1633
Practice Address - Country:US
Practice Address - Phone:415-587-4700
Practice Address - Fax:415-587-8145
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-31
Last Update Date:2014-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA447381223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice