Provider Demographics
NPI:1235297995
Name:HARRIS I MANN DMD LLC
Entity Type:Organization
Organization Name:HARRIS I MANN DMD LLC
Other - Org Name:HARRIS I MANN DMD & ASSOCIATES
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HARRIS
Authorized Official - Middle Name:I
Authorized Official - Last Name:MANN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:215-673-8887
Mailing Address - Street 1:11621 BUSTLETON AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19116-2513
Mailing Address - Country:US
Mailing Address - Phone:215-673-8887
Mailing Address - Fax:215-673-9680
Practice Address - Street 1:11621 BUSTLETON AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19116-2513
Practice Address - Country:US
Practice Address - Phone:215-673-8887
Practice Address - Fax:215-673-9680
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-05
Last Update Date:2008-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS025302L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA447171OtherUCCI