NPIMap

Organization Active NPI

Smiles for Miles, Dental Office of Dr Manosov P.C

  • General Practice Dentistry
  • Modesto, CA
National Provider Identifier
1225169683
Registry record updated Jan 22, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
48326 Issued in CA
Legal business name
SMILES FOR MILES, DENTAL OFFICE OF DR MANOSOV P.C
Practice address
2020 Coffee Rd Ste E
Modesto, CA 95355-2427
Phone
(209) 571-9855
Fax
(209) 571-9874
NPI assigned
Mar 8, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 22, 2021

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

Authorized official

Name
Lea Manosov, DDSNPI 1407961089
Title
Owner
Phone
(209) 571-9855

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X 48326 CA Primary

Addresses

Primary practice location

2020 Coffee Rd Ste E
Modesto, CA 95355-2427

Mailing address

2020 Coffee Rd Ste E
Modesto, CA 95355-2421
Phone (209) 571-9855

Other identifiers 1

IdentifierTypeStateIssuer
G92664-01OtherCADENTI-CAL

Other names 1

  • Smiles for miles Doing business as

National Provider Directory

National Provider Directory

Locations

2020 Coffee Rd
Ste E
Modesto, CA 95355
Phone (209) 571-9855

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1173312000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1611273600000",
    "number": "1225169683",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2020 COFFEE RD STE E",
            "city": "MODESTO",
            "state": "CA",
            "postal_code": "953552421",
            "telephone_number": "209-571-9855",
            "fax_number": "209-571-9874"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2020 COFFEE RD STE E",
            "city": "MODESTO",
            "state": "CA",
            "postal_code": "953552427",
            "telephone_number": "209-571-9855",
            "fax_number": "209-571-9874"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SMILES FOR MILES, DENTAL OFFICE OF DR MANOSOV P.C",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-08",
        "last_updated": "2021-01-22",
        "certification_date": "2021-01-22",
        "status": "A",
        "authorized_official_last_name": "MANOSOV",
        "authorized_official_first_name": "LEA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "209-571-9855",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "48326",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DENTI-CAL",
            "identifier": "G92664-01",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Smiles for miles",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Smiles for miles",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Modesto, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 22, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.