Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 37418 | TX |
NPI | 1003487893 |
---|---|
Provider Name | Brenda M Manzanares |
First Address | Laredo, TX 78041-4354 |
Second Address | Laredo, TX 78041-4354 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/07/2021 |
Last Update Date | 01/09/2021 |