Provider Demographics
NPI:1083198295
Name:MANNEN, JANA KAY (RDH, MSDH)
Entity Type:Individual
Prefix:
First Name:JANA
Middle Name:KAY
Last Name:MANNEN
Suffix:
Gender:F
Credentials:RDH, MSDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2310 CHERRY BEND DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77077-6502
Mailing Address - Country:US
Mailing Address - Phone:713-298-3252
Mailing Address - Fax:
Practice Address - Street 1:2310 CHERRY BEND DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77077-6502
Practice Address - Country:US
Practice Address - Phone:713-298-3252
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-24
Last Update Date:2018-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX15329124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist