Provider Demographics
NPI:1639746498
Name:MANN, JULIETTE CATHERINE (DMD)
Entity Type:Individual
Prefix:DR
First Name:JULIETTE
Middle Name:CATHERINE
Last Name:MANN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 SANCTUARY CT UNIT 102
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29403-6894
Mailing Address - Country:US
Mailing Address - Phone:360-317-8252
Mailing Address - Fax:
Practice Address - Street 1:996 TANNER FORD BLVD
Practice Address - Street 2:
Practice Address - City:HANAHAN
Practice Address - State:SC
Practice Address - Zip Code:29410-4780
Practice Address - Country:US
Practice Address - Phone:360-317-8252
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-09
Last Update Date:2024-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCDGD10388122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist