Provider Demographics
NPI:1740744184
Name:DR. MAN'S DENTAL PRACTICE INC
Entity Type:Organization
Organization Name:DR. MAN'S DENTAL PRACTICE INC
Other - Org Name:WOW DENTAL WEST COVINA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:CHUN PIU
Authorized Official - Middle Name:
Authorized Official - Last Name:MAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:951-505-8862
Mailing Address - Street 1:266 S GLENDORA AVE
Mailing Address - Street 2:
Mailing Address - City:WEST COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91790-3042
Mailing Address - Country:US
Mailing Address - Phone:626-598-3344
Mailing Address - Fax:
Practice Address - Street 1:266 S GLENDORA AVE
Practice Address - Street 2:
Practice Address - City:WEST COVINA
Practice Address - State:CA
Practice Address - Zip Code:91790-3042
Practice Address - Country:US
Practice Address - Phone:626-598-3344
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-30
Last Update Date:2022-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental