Individual
ALDRENE ILANO MANASAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
228 E HOSPITAL RD BLDG 320, FORT EISENHOWER, GA 30905-6011
(706) 787-5102
Mailing address
2110 SYLVAN LAKE DR, GROVETOWN, GA 30813-5852
(706) 787-5102
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
DDS102593
CA
1223E0200X
Endodontics
Primary
13101
TN
1223G0001X
General Practice Dentistry
DDS102593
CA
390200000X
Student in an Organized Health Care Education/Training Program
DDS102593
CA
Other
Enumeration date
08/01/2018
Last updated
08/10/2026
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