Provider Demographics
NPI:1366039539
Name:MANN PACIFIC DENTAL, LLC
Entity Type:Organization
Organization Name:MANN PACIFIC DENTAL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ASHAM
Authorized Official - Middle Name:DEEP
Authorized Official - Last Name:KAUR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:510-378-9802
Mailing Address - Street 1:1630 S PACIFIC AVE STE 104
Mailing Address - Street 2:
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85365-2111
Mailing Address - Country:US
Mailing Address - Phone:510-378-9802
Mailing Address - Fax:928-783-0846
Practice Address - Street 1:1630 S PACIFIC AVE STE 104
Practice Address - Street 2:
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85365-2111
Practice Address - Country:US
Practice Address - Phone:510-378-9802
Practice Address - Fax:928-783-0846
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-22
Last Update Date:2020-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty