Provider Demographics
NPI:1972632685
Name:MANN, PAUL ROBERT (DDS)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:ROBERT
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 1:3351 NE RALPH POWELL RD
Mailing Address - Street 2:
Mailing Address - City:LEES SUMMIT
Mailing Address - State:MO
Mailing Address - Zip Code:64064-2368
Mailing Address - Country:US
Mailing Address - Phone:816-554-7373
Mailing Address - Fax:816-554-7381
Practice Address - Street 1:1286 W FOXWOOD DR
Practice Address - Street 2:
Practice Address - City:RAYMORE
Practice Address - State:MO
Practice Address - Zip Code:64083-8300
Practice Address - Country:US
Practice Address - Phone:816-322-7668
Practice Address - Fax:816-322-7672
Is Sole Proprietor?:No
Enumeration Date:2007-03-06
Last Update Date:2009-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO014710122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist