Individual
ALDRENE 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
Primary
DDS102593
CA
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
07/01/2024
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