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Organization
SMILES FOR MILES, DENTAL OFFICE OF DR MANOSOV P.C
Active
Organization
SMILES FOR MILES, DENTAL OFFICE OF DR MANOSOV P.C
Active
Other names
Smiles for miles
Organization subpart
No
Provider details
NPI number
Authorized official
LEA MANOSOV DDS (OWNER)
(209) 571-9855
Entity
Organization
Contact information
Practice address
2020 COFFEE RD STE E, MODESTO, CA 95355-2427
(209) 571-9855
(209) 571-9874
Mailing address
2020 COFFEE RD STE E, MODESTO, CA 95355-2421
(209) 571-9855
(209) 571-9874
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
48326
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
G92664-01
DENTI-CAL
CA
Enumeration date
03/08/2007
Last updated
01/22/2021
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