Clarisa Kim Mantanona, D.D.S.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

9025 Issued in CO

Practice address

1920 Vindicator Dr
Suite 211
Colorado Springs, CO 80919-3624

Phone

(719) 314-2088

Fax

(719) 314-2089

NPI assigned

Sep 27, 2006

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 CO

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.

• Clarisa Mantanona Family Dentistry, P.C.

  • Dentist
  • Colorado Springs, CO
  • NPI 1760708176
  NPD (past) Authorized official

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

{
    "created_epoch": "1159315200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1270771200000",
    "number": "1255422853",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1920 VINDICATOR DR",
            "address_2": "SUITE 211",
            "city": "COLORADO SPRINGS",
            "state": "CO",
            "postal_code": "809193624",
            "telephone_number": "719-314-2088",
            "fax_number": "719-314-2089"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1920 VINDICATOR DR",
            "address_2": "SUITE 211",
            "city": "COLORADO SPRINGS",
            "state": "CO",
            "postal_code": "809193624",
            "telephone_number": "719-314-2088",
            "fax_number": "719-314-2089"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MANTANONA",
        "first_name": "CLARISA",
        "middle_name": "KIM",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-09-27",
        "last_updated": "2010-04-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CO",
            "license": "9025",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Fernando Martin Manrique Ruiz
• Madeline Mansfield, LPCC
• Kelsey Mansheim, D.O.
• Kaileigh Manson
• Jennifer Mansur, L.AC., DIPL. AC.
• Jaedyn Manteufel
• Jean Marie Manthei, LPC, CACIII
• Jose G. Mantilla-Acevedo, NP
• Sabrina Manto
• Kathryn 'KC' Mantravadi, MA, MFTC, LPCC

• General Practice Dentistry in Colorado Springs, CO
• Providers in Colorado Springs, CO by specialty
• General Practice Dentistry in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 9, 2010; 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.