Provider Demographics
NPI:1609652635
Name:DR.MANN FAMILY DENTAL CARE LLC
Entity Type:Organization
Organization Name:DR.MANN FAMILY DENTAL CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:AJAYPAL
Authorized Official - Middle Name:
Authorized Official - Last Name:MANN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:131-297-3972
Mailing Address - Street 1:10189 ABBY LN
Mailing Address - Street 2:
Mailing Address - City:HAYWARD
Mailing Address - State:WI
Mailing Address - Zip Code:54843-3543
Mailing Address - Country:US
Mailing Address - Phone:131-297-3972
Mailing Address - Fax:
Practice Address - Street 1:507 CHERRY LN
Practice Address - Street 2:
Practice Address - City:ROBERTS
Practice Address - State:WI
Practice Address - Zip Code:54023-9731
Practice Address - Country:US
Practice Address - Phone:312-973-9728
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-05
Last Update Date:2023-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental