Provider Demographics
NPI:1477821916
Name:MANKOWSKI, GERIANNE MARIE (RDHAP)
Entity Type:Individual
Prefix:
First Name:GERIANNE
Middle Name:MARIE
Last Name:MANKOWSKI
Suffix:
Gender:F
Credentials:RDHAP
Other - Prefix:
Other - First Name:GERIANNE
Other - Middle Name:MARIE
Other - Last Name:MANKOWSKI-MCGRATH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RDH,AP
Mailing Address - Street 1:270 N EL CAMINO REAL # F-323
Mailing Address - Street 2:
Mailing Address - City:ENCINITAS
Mailing Address - State:CA
Mailing Address - Zip Code:92024-2874
Mailing Address - Country:US
Mailing Address - Phone:760-212-2863
Mailing Address - Fax:
Practice Address - Street 1:350 SHAWN ELISE WAY
Practice Address - Street 2:
Practice Address - City:ENCINITAS
Practice Address - State:CA
Practice Address - Zip Code:92024-2942
Practice Address - Country:US
Practice Address - Phone:760-212-2863
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-12
Last Update Date:2011-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARDHAP 365124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist