Provider Demographics
NPI:1295090678
Name:GREGORY R, MANNING, DDS PLLC
Entity type:Organization
Organization Name:GREGORY R, MANNING, DDS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DDS / OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:R
Authorized Official - Last Name:MANNING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-988-2373
Mailing Address - Street 1:4365 E PECOS RD STE 132
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85295-8052
Mailing Address - Country:US
Mailing Address - Phone:480-988-2373
Mailing Address - Fax:480-988-2474
Practice Address - Street 1:4365 E PECOS RD STE 132
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85295-8052
Practice Address - Country:US
Practice Address - Phone:480-988-2373
Practice Address - Fax:480-988-2474
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-11
Last Update Date:2016-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7453332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment