Individual
HEATHER M. MANOGUE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.M.D.
Contact information
Practice address
1400 6TH AVE S, BIRMINGHAM, AL 35233-1502
(205) 930-1015
(205) 930-1448
Mailing address
1400 6TH AVE S, BIRMINGHAM, AL 35233-1502
(205) 930-1015
(205) 930-1448
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
5589
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
110180
—
AL
05
—
110186
—
AL
05
—
110235
—
AL
05
—
110259
—
AL
01
—
1245305572
GROUP PAYEE NPI
AL
01
—
1356417935
GROUP PAYEE NPI
AL
01
—
1558437905
GROUP PAYEE NPI
AL
01
—
1861567190
GROUP PAYEE NPI
AL
01
—
515-98177
BLUE SHIELD OF ALABAMA
AL
01
—
515-98178
BLUE SHIELD OF ALABAMA
AL
01
—
515-98179
BLUE SHIELD OF ALABAMA
AL
01
—
515-98180
BLUE SHIELD OF ALABAMA
AL
Enumeration date
06/07/2007
Last updated
03/22/2010
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