Provider Demographics
NPI:1316207897
Name:MANOR PEDIATRIC DENTAL ASSOCIATES PA
Entity Type:Organization
Organization Name:MANOR PEDIATRIC DENTAL ASSOCIATES PA
Other - Org Name:MANOR KIDS DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DON
Authorized Official - Middle Name:
Authorized Official - Last Name:HARTSFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:512-417-9101
Mailing Address - Street 1:8900 LONE TREE DR
Mailing Address - Street 2:
Mailing Address - City:MANOR
Mailing Address - State:TX
Mailing Address - Zip Code:78653-4843
Mailing Address - Country:US
Mailing Address - Phone:512-417-9101
Mailing Address - Fax:
Practice Address - Street 1:13419 US HIGHWAY 290 E
Practice Address - Street 2:BLDG 9
Practice Address - City:MANOR
Practice Address - State:TX
Practice Address - Zip Code:78653-4589
Practice Address - Country:US
Practice Address - Phone:512-417-9101
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-18
Last Update Date:2012-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty
No1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty