Provider Demographics
NPI:1578901617
Name:MANKE, RORY BRET (DDS)
Entity Type:Individual
Prefix:DR
First Name:RORY
Middle Name:BRET
Last Name:MANKE
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 1:2401 S WASHINGTON ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:GRAND FORKS
Mailing Address - State:ND
Mailing Address - Zip Code:58201-6747
Mailing Address - Country:US
Mailing Address - Phone:701-610-3673
Mailing Address - Fax:
Practice Address - Street 1:2401 S WASHINGTON ST
Practice Address - Street 2:SUITE B
Practice Address - City:GRAND FORKS
Practice Address - State:ND
Practice Address - Zip Code:58201-6747
Practice Address - Country:US
Practice Address - Phone:701-610-3673
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-11
Last Update Date:2013-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND21741223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice