Provider Demographics
NPI:1609887884
Name:MANNING, BRYAN A (DDS)
Entity Type:Individual
Prefix:DR
First Name:BRYAN
Middle Name:A
Last Name:MANNING
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 1:1910 MAPLEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:SULPHUR
Mailing Address - State:LA
Mailing Address - Zip Code:70663-6006
Mailing Address - Country:US
Mailing Address - Phone:337-625-8787
Mailing Address - Fax:337-625-9835
Practice Address - Street 1:1910 MAPLEWOOD DR
Practice Address - Street 2:
Practice Address - City:SULPHUR
Practice Address - State:LA
Practice Address - Zip Code:70663-6006
Practice Address - Country:US
Practice Address - Phone:337-625-8787
Practice Address - Fax:337-625-9835
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA5194122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1851949Medicaid