Provider Demographics
NPI:1295862860
Name:MANNING, MARISSA JEANETTE (RDH)
Entity Type:Individual
Prefix:MS
First Name:MARISSA
Middle Name:JEANETTE
Last Name:MANNING
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:621 132ND ST NW
Mailing Address - Street 2:
Mailing Address - City:GIG HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98332-9646
Mailing Address - Country:US
Mailing Address - Phone:253-858-9969
Mailing Address - Fax:
Practice Address - Street 1:7116 STINSON AVE STE B315
Practice Address - Street 2:
Practice Address - City:GIG HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98335-1100
Practice Address - Country:US
Practice Address - Phone:253-858-3457
Practice Address - Fax:253-853-4265
Is Sole Proprietor?:No
Enumeration Date:2007-02-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADH00006241124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist