Provider Demographics
NPI:1255589743
Name:MANZER, RONALD GILES (DDS)
Entity type:Individual
Prefix:DR
First Name:RONALD
Middle Name:GILES
Last Name:MANZER
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:P.O. BOX 259
Mailing Address - Street 2:
Mailing Address - City:MT. AIRY
Mailing Address - State:MD
Mailing Address - Zip Code:21771
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:106 PROSPECT RD.
Practice Address - Street 2:SUITE 5
Practice Address - City:MT. AIRY
Practice Address - State:MD
Practice Address - Zip Code:21771
Practice Address - Country:US
Practice Address - Phone:301-829-2277
Practice Address - Fax:301-829-0256
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-09
Last Update Date:2008-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD5919122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD527021OtherUNITED CONCORDIA