Theron Angus Manson I, DDS

Primary specialty

DentistTaxonomy code 122300000X

License

9434 Issued in WA

Practice address

9750 NE 120TH PL #8
Kirkland, WA 98034-4207

Phone

(425) 823-1909

Fax

(425) 823-8969

NPI assigned

Nov 8, 2006

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in WA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Theron Manson DDS PS

  • Dentist
  • Kirkland, WA
  • NPI 1962754762
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1162944000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1349740800000",
    "number": "1073683074",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9750 NE 120TH PL #8",
            "city": "KIRKLAND",
            "state": "WA",
            "postal_code": "980344207",
            "telephone_number": "425-823-1909",
            "fax_number": "425-823-8969"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9750 NE 120TH PL #8",
            "city": "KIRKLAND",
            "state": "WA",
            "postal_code": "980344207",
            "telephone_number": "425-823-1909",
            "fax_number": "425-823-8969"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MANSON",
        "first_name": "THERON",
        "middle_name": "ANGUS",
        "name_suffix": "I",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-11-08",
        "last_updated": "2012-10-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "WA",
            "license": "DE00009434",
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "WA",
            "license": "9434",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5047998",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Scott Mangum, COTA
• Carl Manhardt, PHARMD
• Alyssa Manke
• Jessica Mannard
• Fredrik Mansfield, MSW, MDIV
• Iqra Mansoor
• Sheila Nicole Mansurov, MA, LMHC, SOTP
• Manual Therapy International P.S., P.L.L.C.
• Judi Lee Mar-Burbidge, PHARMD, FASCP
• Douglas H Mar, OD

• Dentist in Kirkland, WA
• Providers in Kirkland, WA by specialty
• Dentist in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 9, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.