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

Last updated

Jul 24, 2012By the provider in NPPES

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Pda Holdings West, LLC

  dba Magic Smiles Dental Care

  • 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": []
}

• Gabriella Mamo, DO
• Meer Mamood
• 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
• Ruben Anthony Mancha III
• Sanjay Manchanda, M.A. PH.D. LMFT

• 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.