Provider Demographics
NPI:1336218585
Name:MANNING, GREGORY GENE (DDS)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:GENE
Last Name:MANNING
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:PO BOX 69
Mailing Address - Street 2:
Mailing Address - City:BROADWAY
Mailing Address - State:NC
Mailing Address - Zip Code:27505
Mailing Address - Country:US
Mailing Address - Phone:919-258-9811
Mailing Address - Fax:919-258-5204
Practice Address - Street 1:105 CHURCH STREET
Practice Address - Street 2:
Practice Address - City:BROADWAY
Practice Address - State:NC
Practice Address - Zip Code:27505
Practice Address - Country:US
Practice Address - Phone:919-258-9811
Practice Address - Fax:919-258-5204
Is Sole Proprietor?:No
Enumeration Date:2006-11-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC63611223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC9008VMedicaid
9008VOtherBCBS
9008VOtherBCBS