Provider Demographics
NPI:1184382236
Name:MANSKI, MARION C (MS, RDH)
Entity type:Individual
Prefix:PROF
First Name:MARION
Middle Name:C
Last Name:MANSKI
Suffix:
Gender:F
Credentials:MS, RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:60 LAFAYETTE ST # 411
Mailing Address - Street 2:
Mailing Address - City:BRIDGEPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06604-7719
Mailing Address - Country:US
Mailing Address - Phone:443-827-5588
Mailing Address - Fax:
Practice Address - Street 1:60 LAFAYETTE ST # 411
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:CT
Practice Address - Zip Code:06604-7719
Practice Address - Country:US
Practice Address - Phone:443-827-5588
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-06
Last Update Date:2021-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT003904124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist