Provider Demographics
NPI:1336265289
Name:MANSKY, PAUL CHRIS (DDS)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:CHRIS
Last Name:MANSKY
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 1:2950 HYLANE DR
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48098-4289
Mailing Address - Country:US
Mailing Address - Phone:248-433-1277
Mailing Address - Fax:
Practice Address - Street 1:1155 E LONG LAKE RD
Practice Address - Street 2:SUITE 8
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48085-4942
Practice Address - Country:US
Practice Address - Phone:248-689-5508
Practice Address - Fax:248-689-1420
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010141091223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice