Marc Manangan Serra, DDS, FACS

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

DE 60272622 Issued in WA

Practice address

Madigan Army Medical Center 9040 Jackson Ave
Tacoma, WA 98431-0001

Phone

(253) 968-0178

NPI assigned

Aug 9, 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

Opted out of Medicare

Yes, effective Apr 15, 2022 through Apr 15, 2028

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.

• South Sound Ambulatory Surgery Center, PLLC

  • Oral & Maxillofacial Surgery (D.M.D.)
  • Olympia, WA
  • NPI 1487183000
  NPD (past)
• South Sound Oral Surgery PLLC

  • Oral and Maxillofacial Surgery (Dentist)
  • Olympia, WA
  • NPI 1407944614
  NPD (past)

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

{
    "created_epoch": "1155081600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1680652800000",
    "number": "1316957442",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3010 NARROWS PL",
            "city": "TACOMA",
            "state": "WA",
            "postal_code": "984071058"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "MADIGAN ARMY MEDICAL CENTER 9040 JACKSON AVE",
            "city": "TACOMA",
            "state": "WA",
            "postal_code": "984310001",
            "telephone_number": "253-968-0178"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SERRA",
        "first_name": "MARC",
        "middle_name": "MANANGAN",
        "name_prefix": "Dr.",
        "credential": "DDS, FACS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-09",
        "last_updated": "2023-04-05",
        "certification_date": "2023-04-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "171000000X",
            "taxonomy_group": "",
            "desc": "Military Health Care Provider",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "WA",
            "license": "DE 60272622",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Serenity Behavioral Health PLLC
• Serenity Holistic Health & Massage
• Serenity Mental Healthcare PLLC
• Serenity Psychiatric Care PLLC
• Serenity Spa, Inc.
• Renee Makowski Serra, MD
• Andrea F Serrano
• Duane E Serrano, CO61200074
• Elizabeth Marie Serrano, LPN
• Lizette Serrato

• Oral and Maxillofacial Surgery (Dentist) in Tacoma, WA
• Providers in Tacoma, WA by specialty
• Oral and Maxillofacial Surgery (Dentist) in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 5, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.