Justine Calazan Manalastas, DMD

Primary specialty

DentistTaxonomy code 122300000X

License

D008502 Issued in AZ

Practice address

5504 E 22ND St Ste 140
Tucson, AZ 85711-5586

Phone

(520) 777-0790

NPI assigned

Jul 24, 2012

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in AZ

Eligible to order & refer

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

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.

• Pda Holdings West, LLC

  • Dental Clinic/Center
  • Phoenix, AZ
  • NPI 1760188098
  NPD (past)

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

{
    "created_epoch": "1343088000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1343088000000",
    "number": "1174879449",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5504 E 22ND ST STE 140",
            "city": "TUCSON",
            "state": "AZ",
            "postal_code": "857115586",
            "telephone_number": "520-777-0790"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5504 E 22ND ST STE 140",
            "city": "TUCSON",
            "state": "AZ",
            "postal_code": "857115586",
            "telephone_number": "520-777-0790"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MANALASTAS",
        "first_name": "JUSTINE",
        "middle_name": "CALAZAN",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-07-24",
        "last_updated": "2012-07-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "AZ",
            "license": "D008502",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mammography Partners LLC
• Gabriella Mamo, DO
• Mana'Olana Speech Therapy
• Jason Jose Manakat, PA-C
• Nessa Marie Manalang, CRNA
• Maria Linda Manalo, NP
• Angela Gloria Manansala, M.D.
• Carly Mance, LPC
• Sanjay Manchanda, M.A. PH.D. LMFT
• Peter Jonathan Manchen, DO

• Dentist in Tucson, AZ
• Providers in Tucson, AZ by specialty
• Dentist in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 24, 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.