Provider Demographics
NPI:1144985508
Name:MICHAEL MANISCALCO, DMD PC
Entity type:Organization
Organization Name:MICHAEL MANISCALCO, DMD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FINANCIAL COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:TARA
Authorized Official - Middle Name:
Authorized Official - Last Name:SWANNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-967-9100
Mailing Address - Street 1:3419 COLONNADE PARKWAY ST 700
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35243
Mailing Address - Country:US
Mailing Address - Phone:205-967-9100
Mailing Address - Fax:205-967-3032
Practice Address - Street 1:3419 COLONNADE PARKWAY ST 700
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35243
Practice Address - Country:US
Practice Address - Phone:205-967-9100
Practice Address - Fax:205-967-3032
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-01
Last Update Date:2021-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty