Provider Demographics
NPI:1336130343
Name:MANN, CHRISTINA JOY (DMD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTINA
Middle Name:JOY
Last Name:MANN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4112 LAWLESS ST
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78723-5393
Mailing Address - Country:US
Mailing Address - Phone:512-550-4201
Mailing Address - Fax:
Practice Address - Street 1:8017 MESA DR
Practice Address - Street 2:SUITE 101
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78731-1300
Practice Address - Country:US
Practice Address - Phone:512-345-0289
Practice Address - Fax:512-345-6003
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-31
Last Update Date:2013-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX26027122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist