Provider Demographics
NPI:1316483282
Name:MCMANUS, MICHELLE MARIE (DDS, MS)
Entity type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:MARIE
Last Name:MCMANUS
Suffix:
Gender:F
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2804 24TH ST
Mailing Address - Street 2:UNIT #1
Mailing Address - City:ROCK ISLAND
Mailing Address - State:IL
Mailing Address - Zip Code:61201-5360
Mailing Address - Country:US
Mailing Address - Phone:309-558-0075
Mailing Address - Fax:
Practice Address - Street 1:2334 31ST AVE
Practice Address - Street 2:SUITE #1
Practice Address - City:ROCK ISLAND
Practice Address - State:IL
Practice Address - Zip Code:61201-6248
Practice Address - Country:US
Practice Address - Phone:309-558-0075
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-16
Last Update Date:2017-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190281611223X0400X
IL0210023811223X0400X
IA088131223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics