Provider Demographics
NPI:1699069641
Name:AILEEN V. MANZANO D.M.D. INC.
Entity type:Organization
Organization Name:AILEEN V. MANZANO D.M.D. INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:AILEEN
Authorized Official - Middle Name:VELARDE
Authorized Official - Last Name:MANZANO
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:707-469-8523
Mailing Address - Street 1:3000 ALAMO DR STE 108
Mailing Address - Street 2:
Mailing Address - City:VACAVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95687-6345
Mailing Address - Country:US
Mailing Address - Phone:707-469-8523
Mailing Address - Fax:707-469-8525
Practice Address - Street 1:3000 ALAMO DR STE 108
Practice Address - Street 2:
Practice Address - City:VACAVILLE
Practice Address - State:CA
Practice Address - Zip Code:95687-6345
Practice Address - Country:US
Practice Address - Phone:707-469-8523
Practice Address - Fax:707-469-8525
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-07
Last Update Date:2011-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACA457311223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty