Provider Demographics
NPI:1083787667
Name:MANN, PAULA A
Entity Type:Individual
Prefix:
First Name:PAULA
Middle Name:A
Last Name:MANN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:290 RILEYVILLE RD
Mailing Address - Street 2:
Mailing Address - City:EAST AMWELL
Mailing Address - State:NJ
Mailing Address - Zip Code:08525
Mailing Address - Country:US
Mailing Address - Phone:732-236-0053
Mailing Address - Fax:
Practice Address - Street 1:112 OXFORD LANE
Practice Address - Street 2:
Practice Address - City:ABERDEEN
Practice Address - State:NJ
Practice Address - Zip Code:07747
Practice Address - Country:US
Practice Address - Phone:732-566-8484
Practice Address - Fax:732-566-2746
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ135181223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice