Provider Demographics
NPI:1336112036
Name:MANNING, JAN ALEXANDRIA (DDS)
Entity Type:Individual
Prefix:DR
First Name:JAN
Middle Name:ALEXANDRIA
Last Name:MANNING
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:JAN
Other - Middle Name:
Other - Last Name:MANNING
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:862 MUNSON AVE
Mailing Address - Street 2:
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49686-3602
Mailing Address - Country:US
Mailing Address - Phone:231-946-4443
Mailing Address - Fax:
Practice Address - Street 1:862 MUNSON AVE
Practice Address - Street 2:
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49686-3602
Practice Address - Country:US
Practice Address - Phone:231-946-4443
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901016887122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist