Provider Demographics
NPI:1316957442
Name:SERRA, MARC MANANGAN (DDS, FACS)
Entity type:Individual
Prefix:DR
First Name:MARC
Middle Name:MANANGAN
Last Name:SERRA
Suffix:
Gender:M
Credentials:DDS, FACS
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:3010 NARROWS PL
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98407-1058
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:MADIGAN ARMY MEDICAL CENTER 9040 JACKSON AVE
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98431-0001
Practice Address - Country:US
Practice Address - Phone:253-968-0178
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2023-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171000000X
WADE 602726221223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
No171000000XOther Service ProvidersMilitary Health Care Provider