Provider Demographics
NPI:1316219041
Name:MANBECK, MAXWELL ROSS (DDS)
Entity Type:Individual
Prefix:DR
First Name:MAXWELL
Middle Name:ROSS
Last Name:MANBECK
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 1:2891 INDUSTRIAL PARK RD
Mailing Address - Street 2:
Mailing Address - City:MIFFLINTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:17059-9077
Mailing Address - Country:US
Mailing Address - Phone:717-436-5631
Mailing Address - Fax:
Practice Address - Street 1:2891 INDUSTRIAL PARK RD
Practice Address - Street 2:
Practice Address - City:MIFFLINTOWN
Practice Address - State:PA
Practice Address - Zip Code:17059-9077
Practice Address - Country:US
Practice Address - Phone:717-436-5631
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-26
Last Update Date:2012-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS-027671-L122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist