Provider Demographics
NPI:1902470347
Name:MCMANAMON, DALLAS (DMD)
Entity Type:Individual
Prefix:DR
First Name:DALLAS
Middle Name:
Last Name:MCMANAMON
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6615 W ARGENT RD
Mailing Address - Street 2:
Mailing Address - City:PASCO
Mailing Address - State:WA
Mailing Address - Zip Code:99301-1905
Mailing Address - Country:US
Mailing Address - Phone:509-547-9951
Mailing Address - Fax:
Practice Address - Street 1:6615 W ARGENT RD
Practice Address - Street 2:
Practice Address - City:PASCO
Practice Address - State:WA
Practice Address - Zip Code:99301-1905
Practice Address - Country:US
Practice Address - Phone:509-547-9951
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-19
Last Update Date:2021-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE611506571223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice