Provider Demographics
NPI:1013027093
Name:MANN, ALFRED WESLEY III (DMD)
Entity Type:Individual
Prefix:DR
First Name:ALFRED
Middle Name:WESLEY
Last Name:MANN
Suffix:III
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6609 RIDGE ROAD
Mailing Address - Street 2:SUITE 6
Mailing Address - City:PORT RICHEY
Mailing Address - State:FL
Mailing Address - Zip Code:34668-6839
Mailing Address - Country:US
Mailing Address - Phone:727-842-8272
Mailing Address - Fax:727-842-8331
Practice Address - Street 1:6609 RIDGE ROAD
Practice Address - Street 2:SUITE 6
Practice Address - City:PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34668-6839
Practice Address - Country:US
Practice Address - Phone:727-842-8272
Practice Address - Fax:727-842-8331
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL5442122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist