Provider Demographics
NPI:1235465428
Name:JARRETT L. MANNING, DDS, PC
Entity Type:Organization
Organization Name:JARRETT L. MANNING, DDS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JARRETT
Authorized Official - Middle Name:L
Authorized Official - Last Name:MANNING
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MPH
Authorized Official - Phone:678-640-5272
Mailing Address - Street 1:4450 S COBB DR SE
Mailing Address - Street 2:
Mailing Address - City:SMYRNA
Mailing Address - State:GA
Mailing Address - Zip Code:30080-6329
Mailing Address - Country:US
Mailing Address - Phone:770-433-1515
Mailing Address - Fax:770-433-0039
Practice Address - Street 1:4450 S COBB DR SE
Practice Address - Street 2:
Practice Address - City:SMYRNA
Practice Address - State:GA
Practice Address - Zip Code:30080-6329
Practice Address - Country:US
Practice Address - Phone:770-433-1515
Practice Address - Fax:770-433-0039
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-23
Last Update Date:2009-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN013349122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty