Provider Demographics
NPI:1346330479
Name:MANN, JAMES LESTER (DDS)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:LESTER
Last Name:MANN
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 1:3362 S MCCARRAN BLVD
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89502-6442
Mailing Address - Country:US
Mailing Address - Phone:775-329-5437
Mailing Address - Fax:775-829-1553
Practice Address - Street 1:3362 S MCCARRAN BLVD
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89502-6442
Practice Address - Country:US
Practice Address - Phone:775-329-5437
Practice Address - Fax:775-829-1553
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2015-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV51691223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV100510490Medicaid
NV1936346OtherUNITED CONCORDIA