Provider Demographics
NPI:1639352289
Name:PETER L MANIS DMD PC
Entity Type:Organization
Organization Name:PETER L MANIS DMD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRES OF CORP
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:L
Authorized Official - Last Name:MANIS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:978-374-0863
Mailing Address - Street 1:145 KENOZA AVE
Mailing Address - Street 2:
Mailing Address - City:HAVERHILL
Mailing Address - State:MA
Mailing Address - Zip Code:01830-4141
Mailing Address - Country:US
Mailing Address - Phone:978-374-0863
Mailing Address - Fax:978-374-0527
Practice Address - Street 1:145 KENOZA AVE
Practice Address - Street 2:
Practice Address - City:HAVERHILL
Practice Address - State:MA
Practice Address - Zip Code:01830-4141
Practice Address - Country:US
Practice Address - Phone:978-374-0863
Practice Address - Fax:978-374-0527
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PETER L MANIS DMD PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-12-06
Last Update Date:2007-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAMA102931223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty