Provider Demographics
NPI:1154447514
Name:MANNING, ROBERT (DMD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:MANNING
Suffix:
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 69
Mailing Address - Street 2:1612 HWY 51 N
Mailing Address - City:WINONA
Mailing Address - State:MS
Mailing Address - Zip Code:38967-0069
Mailing Address - Country:US
Mailing Address - Phone:662-283-4525
Mailing Address - Fax:
Practice Address - Street 1:1612 HWY 51 N
Practice Address - Street 2:
Practice Address - City:WINONA
Practice Address - State:MS
Practice Address - Zip Code:38967
Practice Address - Country:US
Practice Address - Phone:662-283-4525
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS2879951223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS287995OtherLICENCE NUMBER