Provider Demographics
NPI:1447230966
Name:MANN, RICHARD K (DDS)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:K
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 1:7100 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80221-2917
Mailing Address - Country:US
Mailing Address - Phone:303-650-5800
Mailing Address - Fax:303-650-5800
Practice Address - Street 1:7100 BROADWAY
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80221-2917
Practice Address - Country:US
Practice Address - Phone:303-650-5800
Practice Address - Fax:303-650-5800
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-19
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO6372122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO81904843Medicaid