Provider Demographics
NPI:1073544672
Name:MANN, JOHN III (DMD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:
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:PO BOX D
Mailing Address - Street 2:
Mailing Address - City:POCONO PINES
Mailing Address - State:PA
Mailing Address - Zip Code:18350-0150
Mailing Address - Country:US
Mailing Address - Phone:570-646-7811
Mailing Address - Fax:570-643-9747
Practice Address - Street 1:5 MCCAULEY AVE
Practice Address - Street 2:
Practice Address - City:POCONO PINES
Practice Address - State:PA
Practice Address - Zip Code:18350
Practice Address - Country:US
Practice Address - Phone:570-646-7811
Practice Address - Fax:570-643-9747
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0350291223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice