Active NPI
Heather Manka, DMD
- Dentist
- Grand Ronde, OR
National Provider Identifier
1063966356
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- D10508
- Practice address
- 9605 Grand Ronde Rd
Grand Ronde, OR 97347-9712 - Phone
- (503) 879-2020
- Fax
- (503) 879-2071
- NPI assigned
- Aug 4, 2016
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | D10508 | OR | Primary |
Addresses
Primary practice location
9605 Grand Ronde Rd
Grand Ronde, OR 97347-9712
Mailing address
9605 Grand Ronde Rd
Grand Ronde, OR 97347-9712
Phone (503) 879-2020
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| D10508 | OR | MD | Dentist |
Interoperability endpoints
- heather.manka.p1@direct.grandronde.nextgenshare.com
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1470268800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1738108800000",
"number": "1063966356",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9605 GRAND RONDE RD",
"city": "GRAND RONDE",
"state": "OR",
"postal_code": "973479712",
"telephone_number": "503-879-2020",
"fax_number": "503-879-2071"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9605 GRAND RONDE RD",
"city": "GRAND RONDE",
"state": "OR",
"postal_code": "973479712",
"telephone_number": "503-879-2020",
"fax_number": "503-879-2071"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MANKA",
"first_name": "HEATHER",
"credential": "DMD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2016-08-04",
"last_updated": "2025-01-29",
"certification_date": "2025-01-29",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "OR",
"license": "D10508",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Grand Ronde, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 29, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.