John Kenneth Gruspe Manalo

Primary specialty

DentistTaxonomy code 122300000X

License

D012515 Issued in AZ

Practice address

15920 S Rancho Sahuarita Blvd Ste 100
Sahuarita, AZ 85629-8013

Phone

(520) 838-0600

NPI assigned

May 23, 2025

Sex

Male

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not 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.

• Coppermine Dental Studio at Madera Canyon PLLC

  • Dentist
  • Green Valley, AZ
  • NPI 1811479074
  NPD (past)
• Coppermine Madera Canyon LLC

  dba Coppermine Dental Studio

  • General Practice Dentistry
  • Green Valley, AZ
  • NPI 1679326938
  NPD (past)

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

{
    "created_epoch": "1747958400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1748822400000",
    "number": "1407649437",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1404 N BLUE SAHUARO TRL",
            "city": "TUCSON",
            "state": "AZ",
            "postal_code": "857155248",
            "telephone_number": "520-248-2763"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15920 S RANCHO SAHUARITA BLVD STE 100",
            "city": "SAHUARITA",
            "state": "AZ",
            "postal_code": "856298013",
            "telephone_number": "520-838-0600"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "685 S Pecan Tree Ln",
            "address_purpose": "LOCATION",
            "city": "Green Valley",
            "state": "AZ",
            "postal_code": "856145114",
            "country_code": "US",
            "telephone_number": "520-625-1600",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MANALO",
        "first_name": "JOHN KENNETH",
        "middle_name": "GRUSPE",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2025-05-23",
        "last_updated": "2025-06-02",
        "certification_date": "2025-06-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "AZ",
            "license": "D012515",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• William Clyde Lucas, FNP
• William Gene Lucas, FNP-C
• Jonathan Ma
• Jenifer Hope Maeser
• Emery Mahoney, PH.D
• Lisett M Marquez, LCSW
• Gordon H Marrs, RPH
• Brody McCarter, LMT
• Riley McCoy
• Michele McCullough-Cruz, LCSW

• Dentist in Sahuarita, AZ
• Providers in Sahuarita, AZ by specialty
• Dentist in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 2, 2025; 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.