Provider Demographics
NPI:1134232838
Name:MANKE, CHRISTOPHER (DDS)
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:
Last Name:MANKE
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 1:200 CLOCK TOWER PL
Mailing Address - Street 2:201-D
Mailing Address - City:CARMEL
Mailing Address - State:CA
Mailing Address - Zip Code:93923-8723
Mailing Address - Country:US
Mailing Address - Phone:831-624-3740
Mailing Address - Fax:
Practice Address - Street 1:200 CLOCK TOWER PL
Practice Address - Street 2:201-D
Practice Address - City:CARMEL
Practice Address - State:CA
Practice Address - Zip Code:93923-8723
Practice Address - Country:US
Practice Address - Phone:831-624-3740
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA27794122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist