Moran Manosov

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

109599 Issued in CA

Practice address

2020 Coffee Rd Ste E1
Modesto, CA 95355-2421

Phone

(209) 571-9855

NPI assigned

Oct 17, 2023

Last updated

Oct 17, 2023By 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 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1697500800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1697500800000",
    "number": "1972385714",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2619 AURORA ASTORGA DR",
            "city": "TRACY",
            "state": "CA",
            "postal_code": "953768202",
            "telephone_number": "408-857-9046"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2020 COFFEE RD STE E1",
            "city": "MODESTO",
            "state": "CA",
            "postal_code": "953552421",
            "telephone_number": "209-571-9855"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MANOSOV",
        "first_name": "MORAN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2023-10-17",
        "last_updated": "2023-10-17",
        "certification_date": "2023-10-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "109599",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Surjit Mann
• Sasi Kala Mannem, D.D.S.
• Arun Manoharan, MD
• Lea Manosov, DDS
• Liran Manosov, DDS
• Madison Jonna Manrique
• Angel Manriquez
• Jhonatan Manriquez
• Joseph Sami Mansour, MD
• Mary Manter, BCBA, MA

• General Practice Dentistry in Modesto, CA
• Providers in Modesto, CA by specialty
• General Practice Dentistry in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 17, 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.