Provider Demographics
NPI:1720218985
Name:ROBERT J. MANN
Entity Type:Organization
Organization Name:ROBERT J. MANN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:MANN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:651-565-3511
Mailing Address - Street 1:115 MAIN ST E
Mailing Address - Street 2:
Mailing Address - City:WABASHA
Mailing Address - State:MN
Mailing Address - Zip Code:55981-1420
Mailing Address - Country:US
Mailing Address - Phone:651-565-3511
Mailing Address - Fax:651-565-2224
Practice Address - Street 1:115 MAIN ST E
Practice Address - Street 2:
Practice Address - City:WABASHA
Practice Address - State:MN
Practice Address - Zip Code:55981-1420
Practice Address - Country:US
Practice Address - Phone:651-565-3511
Practice Address - Fax:651-565-2224
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-22
Last Update Date:2009-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN82661223G0001X
MND127181223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty