Provider Demographics
NPI:1114935194
Name:MANI, GEORGE (DDS)
Entity Type:Individual
Prefix:MR
First Name:GEORGE
Middle Name:
Last Name:MANI
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1900 SOUTH MAIN STREET
Mailing Address - Street 2:SUITE 206
Mailing Address - City:WAKE FOREST
Mailing Address - State:NC
Mailing Address - Zip Code:27587
Mailing Address - Country:US
Mailing Address - Phone:919-562-7008
Mailing Address - Fax:919-562-9809
Practice Address - Street 1:1900 SOUTH MAIN STREET
Practice Address - Street 2:SUITE 206
Practice Address - City:WAKE FOREST
Practice Address - State:NC
Practice Address - Zip Code:27587
Practice Address - Country:US
Practice Address - Phone:919-562-7008
Practice Address - Fax:919-562-9809
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC59771223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8995446Medicaid
U41821Medicare UPIN