Manuel NMN Pelaez, DMD, MS

Primary specialty

PeriodonticsTaxonomy code 1223P0300X

License

DS035547 Issued in PA

Practice address

USA Dentac Ft Stewart
351 W. 6TH Street
Fort Stewart, GA 31314

Phone

(912) 767-8305

NPI assigned

Mar 14, 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

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Science

State licenses

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

{
    "created_epoch": "1142294400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678752000000",
    "number": "1295703387",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "USA DENTAC FT STEWART",
            "address_2": "351 W. 6TH STREET, SUITE 100",
            "city": "FORT STEWART",
            "state": "GA",
            "postal_code": "31314",
            "telephone_number": "912-767-8305"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "USA DENTAC FT STEWART",
            "address_2": "351 W. 6TH STREET",
            "city": "FORT STEWART",
            "state": "GA",
            "postal_code": "31314",
            "telephone_number": "912-767-8305"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PELAEZ",
        "first_name": "MANUEL",
        "middle_name": "NMN",
        "name_prefix": "Dr.",
        "credential": "DMD, MS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-03-14",
        "last_updated": "2023-03-14",
        "certification_date": "2023-03-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "PA",
            "license": "DS035547",
            "primary": false
        },
        {
            "code": "1223P0300X",
            "taxonomy_group": "",
            "desc": "Dentist, Periodontics",
            "state": "PA",
            "license": "DS035547",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Patrick M Riner OD PC
• Phillip H. Patridge, DMD
• Armanni Patterson
• Terissa Patterson
• Mandy Pears, PHYSICIAN ASSISTANT
• Isabel Pena
• Jacob Penatzer, PA-C
• Charles Hughes Penn Jr., MD
• Quentin Penn
• Shenita Penn, LPN

• Periodontics in Fort Stewart, GA
• Providers in Fort Stewart, GA by specialty
• Periodontics in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 14, 2023; 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.