Provider Demographics
NPI:1659536225
Name:MANWARING, JEREMY DWIGHT (DMD,MS)
Entity Type:Individual
Prefix:DR
First Name:JEREMY
Middle Name:DWIGHT
Last Name:MANWARING
Suffix:
Gender:M
Credentials:DMD,MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6287 S. REDWOOD ROAD
Mailing Address - Street 2:SUITE #102
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84123
Mailing Address - Country:US
Mailing Address - Phone:801-293-8833
Mailing Address - Fax:801-293-8844
Practice Address - Street 1:6287 S. REDWOOD ROAD
Practice Address - Street 2:SUITE#102
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84123
Practice Address - Country:US
Practice Address - Phone:801-293-8833
Practice Address - Fax:801-293-8844
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-23
Last Update Date:2008-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT56827961223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics