Provider Demographics
NPI:1891907036
Name:MANN, FARREL MILES (DDS)
Entity Type:Individual
Prefix:DR
First Name:FARREL
Middle Name:MILES
Last Name:MANN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2216 MACDADE BLVD
Mailing Address - Street 2:
Mailing Address - City:HOLMES
Mailing Address - State:PA
Mailing Address - Zip Code:19043
Mailing Address - Country:US
Mailing Address - Phone:610-532-7752
Mailing Address - Fax:610-532-7752
Practice Address - Street 1:2216 MACDADE BLVD
Practice Address - Street 2:
Practice Address - City:HOLMES
Practice Address - State:PA
Practice Address - Zip Code:19043
Practice Address - Country:US
Practice Address - Phone:610-532-7752
Practice Address - Fax:610-532-7752
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS021458L122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist