Provider Demographics
NPI:1336962315
Name:MANLUCU DENTAL GROUP PC
Entity type:Organization
Organization Name:MANLUCU DENTAL GROUP PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SHANNEN MARIE
Authorized Official - Middle Name:
Authorized Official - Last Name:MANLUCU
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:442-722-7920
Mailing Address - Street 1:16815 CRABBS BRANCH WAY
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20855-2215
Mailing Address - Country:US
Mailing Address - Phone:301-963-4330
Mailing Address - Fax:
Practice Address - Street 1:16815 CRABBS BRANCH WAY
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20855-2215
Practice Address - Country:US
Practice Address - Phone:301-963-4330
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-06
Last Update Date:2024-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty