Tyra Manso, DDS

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

License

22DI023814 Issued in NJ

Practice address

31 Valley Rd
2ND Floor
Montclair, NJ 07042-2708

Phone

(973) 771-5387

NPI assigned

Jul 29, 2008

Last updated

Jun 2, 2016By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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)

Enrolled

State licenses

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

{
    "created_epoch": "1217289600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1464825600000",
    "number": "1467618512",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "31 VALLEY RD",
            "address_2": "2ND FLOOR",
            "city": "MONTCLAIR",
            "state": "NJ",
            "postal_code": "070422708",
            "telephone_number": "973-771-5387"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "31 VALLEY RD",
            "address_2": "2ND FLOOR",
            "city": "MONTCLAIR",
            "state": "NJ",
            "postal_code": "070422708",
            "telephone_number": "973-771-5387"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MANSO",
        "first_name": "TYRA",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2008-07-29",
        "last_updated": "2016-06-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "NJ",
            "license": "22DI023814",
            "primary": true
        },
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "NY",
            "license": "0539911",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Daniela C Mallack
• Carissa E Mancuso, PHARMD
• Rafanny Mangarelli, LCSW
• Mohini Mankikar, M.D.
• Nicholas Anthony Manoussos, DDS
• Sarai Manuel, LMFT
• Many Mothers Lactation Consulting, LLC (Catherine Belonog)
• Daniel Marain, LSW
• Leticia Maravillas
• Carol S Marcus, PHD

• Pediatric Dentistry in Montclair, NJ
• Providers in Montclair, NJ by specialty
• Pediatric Dentistry in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 2, 2016; 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.