Provider Demographics
NPI:1215467238
Name:MANIMTIM, MICHELLE VILLAVERDE (DDS)
Entity type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:VILLAVERDE
Last Name:MANIMTIM
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:780 E ROMIE LN STE A
Mailing Address - Street 2:
Mailing Address - City:SALINAS
Mailing Address - State:CA
Mailing Address - Zip Code:93901-4223
Mailing Address - Country:US
Mailing Address - Phone:831-424-0301
Mailing Address - Fax:
Practice Address - Street 1:780 E ROMIE LN STE A
Practice Address - Street 2:
Practice Address - City:SALINAS
Practice Address - State:CA
Practice Address - Zip Code:93901-4223
Practice Address - Country:US
Practice Address - Phone:831-424-0301
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-13
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CADDS1029221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program