Provider Demographics
NPI:1760091805
Name:DEBRA Z MANNIA P.L.L.C.
Entity Type:Organization
Organization Name:DEBRA Z MANNIA P.L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:
Authorized Official - Last Name:MANNIA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:269-756-5431
Mailing Address - Street 1:103 S ELM ST
Mailing Address - Street 2:
Mailing Address - City:THREE OAKS
Mailing Address - State:MI
Mailing Address - Zip Code:49128-1123
Mailing Address - Country:US
Mailing Address - Phone:269-756-5431
Mailing Address - Fax:
Practice Address - Street 1:103 S ELM ST
Practice Address - Street 2:
Practice Address - City:THREE OAKS
Practice Address - State:MI
Practice Address - Zip Code:49128-1123
Practice Address - Country:US
Practice Address - Phone:269-756-5431
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-24
Last Update Date:2020-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1093025942Medicaid
MI1396956603Medicaid