Provider Demographics
NPI:1205053923
Name:MANN, SAMUEL C (DDS)
Entity type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:C
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 1:608 BLUE POINT RD
Mailing Address - Street 2:
Mailing Address - City:HOLTSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11742-1835
Mailing Address - Country:US
Mailing Address - Phone:631-475-6517
Mailing Address - Fax:
Practice Address - Street 1:608 BLUE POINT RD
Practice Address - Street 2:
Practice Address - City:HOLTSVILLE
Practice Address - State:NY
Practice Address - Zip Code:11742-1835
Practice Address - Country:US
Practice Address - Phone:631-475-6517
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY035230122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist