Provider Demographics
NPI:1730574773
Name:CETTIE-MANZO, DDS, PC
Entity type:Organization
Organization Name:CETTIE-MANZO, DDS, PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:TIFFANY
Authorized Official - Middle Name:
Authorized Official - Last Name:MANZO JENKINS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:520-548-3361
Mailing Address - Street 1:12495 W 32ND AVE
Mailing Address - Street 2:
Mailing Address - City:WHEAT RIDGE
Mailing Address - State:CO
Mailing Address - Zip Code:80033-5288
Mailing Address - Country:US
Mailing Address - Phone:303-297-2707
Mailing Address - Fax:303-237-2680
Practice Address - Street 1:12495 W 32ND AVE
Practice Address - Street 2:
Practice Address - City:WHEAT RIDGE
Practice Address - State:CO
Practice Address - Zip Code:80033-5288
Practice Address - Country:US
Practice Address - Phone:303-297-2707
Practice Address - Fax:303-237-2680
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-06
Last Update Date:2015-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO102691223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty