Provider Demographics
NPI:1275630394
Name:MANN, MARCUS RAZAGHI (DDS)
Entity Type:Individual
Prefix:
First Name:MARCUS
Middle Name:RAZAGHI
Last Name:MANN
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 1:7161 WALERGA RD
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95842-4621
Mailing Address - Country:US
Mailing Address - Phone:916-338-1600
Mailing Address - Fax:
Practice Address - Street 1:7161 WALERGA RD
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95842-4621
Practice Address - Country:US
Practice Address - Phone:916-338-1600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA359761223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice