Provider Demographics
NPI:1831118827
Name:MANNA JR, RALPH (DMD)
Entity Type:Individual
Prefix:DR
First Name:RALPH
Middle Name:
Last Name:MANNA JR
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4701 DUKE ST
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17109-3041
Mailing Address - Country:US
Mailing Address - Phone:717-657-3441
Mailing Address - Fax:
Practice Address - Street 1:4701 DUKE ST
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17109-3041
Practice Address - Country:US
Practice Address - Phone:717-657-3441
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS020315L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice