Provider Demographics
NPI:1780204362
Name:MANIN, PERRIE LYN (DMD)
Entity Type:Individual
Prefix:DR
First Name:PERRIE
Middle Name:LYN
Last Name:MANIN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:DR
Other - First Name:PERRIE
Other - Middle Name:LYN
Other - Last Name:EPSTEIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD
Mailing Address - Street 1:9334 GRAND CORDERA PKWY
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80924-7000
Mailing Address - Country:US
Mailing Address - Phone:719-282-6666
Mailing Address - Fax:
Practice Address - Street 1:9334 GRAND CORDERA PKWY
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80924-7000
Practice Address - Country:US
Practice Address - Phone:719-282-6666
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-23
Last Update Date:2023-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA282NC2000X
CODEN.002050971223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No282NC2000XHospitalsGeneral Acute Care HospitalChildren