DR. MARC MANANGAN SERRA (NPI# 1316957442) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1316957442 |
| Entity Type | Individual |
| Full Name | DR. MARC MANANGAN SERRA |
| Credential | DDS, FACS |
| Practice Address |
9040a Jackson Ave Joint Base Lewis Mcchord WA 98431-0001 |
| Mailing Address |
3010 Narrows Pl Tacoma WA 98407-1058 |
| Practice Telephone | 2539681240 |
| Enumeration Date | 2006-08-09 |
| Last Update Date | 2019-07-10 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1223S0112X |
Dentist Specialization: Oral and Maxillofacial Surgery |
DE 60272622 | WA | Dental Providers |
| N | 171000000X | Military Health Care Provider | Other Service Providers |
| Street Address |
9040A JACKSON AVE |
| City | JOINT BASE LEWIS MCCHORD |
| State | WA |
| Zip Code | 98431-0001 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1336747716 | Melissa Stahl | Occupational Therapist | 9040a Jackson Ave, Joint Base Lewis Mcchord, WA 98431-0001 | 2020-10-16 |
| 1043832090 | Ryan Michael Brock | Pharmacist | 9040a Jackson Ave, Joint Base Lewis Mcchord, WA 98431-0001 | 2020-05-13 |
| 1205457900 | Yang Qu | Physician Assistant | 9040a Jackson Ave, Joint Base Lewis Mcchord, WA 98431-0001 | 2020-05-04 |
| 1275195877 | Michael C Saenz | Licensed Practical Nurse | 9040a Jackson Ave, Joint Base Lewis Mcchord, WA 98431-0001 | 2019-07-03 |
| 1154892792 | Nicholas James Wankum | Physical Therapist | 9040a Jackson Ave, Joint Base Lewis Mcchord, WA 98431-0001 | 2018-12-07 |
| 1942775184 | Rachel Nell Dyal | Nutritionist | 9040a Jackson Ave, Joint Base Lewis Mcchord, WA 98431-0001 | 2018-10-03 |
| 1861998346 | Isaac Ingersoll | General Practice | 9040a Jackson Ave, Joint Base Lewis Mcchord, WA 98431-0001 | 2018-04-03 |
| 1184124687 | Ketan Mehta | General Practice | 9040a Jackson Ave, Joint Base Lewis Mcchord, WA 98431-0001 | 2018-02-20 |
| 1073965851 | Katy L Modlin | Dermatology | 9040a Jackson Ave, Joint Base Lewis Mcchord, WA 98431-5638 | 2016-07-06 |
| 1104286582 | Andrew Zilka | Physician Assistant | 9040a Jackson Ave, Joint Base Lewis Mcchord, WA 98431-0001 | 2016-02-29 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1497212260 | Catrina Renee Grugin | Registered Nurse | Madigan Army Medical Center, Attn Mchj-clq-c, 9040 Jackson Ave, Tacoma, WA 98431 | 2019-02-27 |
| 1801307681 | Bianca Gomez | Dental Assistant | Bldg 9900 Lincoln Street, Jblm, WA 98431 | 2017-10-19 |
| 1184133225 | Darren Paris | Registered Nurse | Madigan Army Medical Center 9040 Jackson Ave., Attn: Mchj-clq-c, Tacoma, WA 98431 | 2017-09-20 |
| 1922538206 | Sarah Frerichs | Dentist | Madigan Annex, Second Floor, Bldg. 9900, Apo, AA 98431 | 2017-06-19 |
| 1740736495 | Misty Hill | Dental Assistant | 9119 Mill Park Ave, Tacoma, WA 98431 | 2016-08-31 |
| 1336695535 | Jacqueline D Massouda | Dentist | Jblm Dentac, 9900 Lincoln Sreet, 2nd Floor, Apo, AA 98431 | 2016-08-28 |
| 1609239375 | Gregg V Palmer | Licensed Practical Nurse | 17th and C Street, Bldg 11582, Tacoma, WA 98431 | 2016-03-31 |
| 1114323904 | Deanna Sheets | Nurse Practitioner | 911 Mil Park Ave, Tacoma, WA 98431 | 2014-11-06 |
| 1679905434 | Austin William Schaar | Dentist | Building 9900, 2nd Floor, Tacoma, WA 98431 | 2013-08-05 |
| 1518209758 | Maurice Ibrahim Khayat | Internal Medicine | 9040 Jackson Ave Mche-qd (creds), Tacoma, WA 98431 | 2013-03-26 |
| Find all providers in zip 98431 | ||||
| Taxonomy Code | 1223S0112X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | Oral and Maxillofacial Surgery |
| The specialty of dentistry which includes the diagnosis, surgical and adjunctive treatment of diseases, injuries and defects involving both the functional and esthetic aspects of the hard and soft tissues of the oral and maxillofacial region. |
| Notes: Source: Council on Dental Education and Licensure, American Dental Association |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1023619657 | Washington Jaw and Facial Surgery Pllc | Dentist | 451 Duvall Ave Ne Ste 100, Renton, WA 98059-4675 | 2020-11-02 |
| 1952909145 | Calley Christie Dmd Pllc | Dentist | 275 Sw 160th St Ste 115, Burien, WA 98166-3003 | 2020-10-11 |
| 1679197016 | Tae Youn Dds Md Pllc | Dentist | 15808 Mill Creek Blvd Ste 202, Mill Creek, WA 98012-1500 | 2020-06-02 |
| 1417416728 | Sam Wise | Dentist | 1538 11th Ave Lowr Columbia, Longview, WA 98632 | 2019-03-16 |
| 1740744374 | Thompson Ferguson Schrack Pllc | Dentist | 7604 Ne 5th Ave Ste 114, Vancouver, WA 98665-8200 | 2019-01-28 |
| 1053875096 | John K Tidwell Dds and Elizabeth A Kutcipal Dds Pllc | Dentist | 1801 Nw Market St Ste 108, Seattle, WA 98107-3909 | 2019-01-23 |
| 1255803904 | Edwards, Johnson, Johnson & Johnson D.d.s., P.l.l.c. | Dentist | 601 S Carr Rd Ste 300, Renton, WA 98055-5840 | 2018-12-19 |
| 1104396969 | Mark Stivers, Dds, Inc., P.s. | Dentist | 12728 19th Ave Se Ste 101, Everett, WA 98208-6526 | 2018-12-04 |
| 1144797499 | Washington Jaw and Facial Surgery Pllc | Dentist | 1370 116th Ave Ne Ste 101, Bellevue, WA 98004-3825 | 2018-10-25 |
| 1780151027 | Washington Jaw and Facial Surgery Pllc | Dentist | 2111 N Northgate Way Ste 105, Seattle, WA 98133-9018 | 2018-10-25 |
| Find all providers with the same taxonomy | ||||
| City | JOINT BASE LEWIS MCCHORD |
| Zip Code | 98431 |
Please comment or provide details below to improve the information on DR. MARC MANANGAN SERRA.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.