Individual provider Active NPI

David James Manzanares, D.D.S.

  • Dentist
  • Albuquerque, NM
National Provider Identifier
1902123722
Registry record updated Dec 5, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
DD 3278 Issued in NM
Practice address
13235 Emery Point Ave NE
Albuquerque, NM 87111-8244
Phone
(505) 670-4439
NPI assigned
May 3, 2010
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 5, 2011

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X DD 3278 NM Primary

Addresses

Primary practice location

13235 Emery Point Ave NE
Albuquerque, NM 87111-8244

Mailing address

13235 Emery Point Ave NE
Albuquerque, NM 87111-8244
Phone (505) 670-4439

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NM
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

Enrollment IDStateProvider typePAC IDDetails
I20160112001565 NM Order and Referring Only - DentistPractitioner - Dentist 3476855115

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
DD 3278NMMDDentist

NPI Registry JSON

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

{
    "created_epoch": "1272844800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1323043200000",
    "number": "1902123722",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13235 EMERY POINT AVE NE",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871118244",
            "telephone_number": "505-670-4439"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13235 EMERY POINT AVE NE",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871118244",
            "telephone_number": "505-670-4439"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MANZANARES",
        "first_name": "DAVID",
        "middle_name": "JAMES",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-05-03",
        "last_updated": "2011-12-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "NM",
            "license": "DD 3278",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Albuquerque, NM

Sources for this page

Verify at the official NPI Registry.