Provider Demographics
NPI:1558430553
Name:MANN, DONALD JOSEPH (DDS)
Entity Type:Individual
Prefix:DR
First Name:DONALD
Middle Name:JOSEPH
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 1:675 IDAHO AVE SE
Mailing Address - Street 2:
Mailing Address - City:HURON
Mailing Address - State:SD
Mailing Address - Zip Code:57350-2843
Mailing Address - Country:US
Mailing Address - Phone:605-353-1166
Mailing Address - Fax:
Practice Address - Street 1:530 IOWA AVE SE
Practice Address - Street 2:SUITE 105
Practice Address - City:HURON
Practice Address - State:SD
Practice Address - Zip Code:57350-2864
Practice Address - Country:US
Practice Address - Phone:605-352-4974
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDM4851223G0001X
AK10181223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice