Provider Demographics
NPI:1336367184
Name:GEORGE MANI, DDS, PA
Entity Type:Organization
Organization Name:GEORGE MANI, DDS, PA
Other - Org Name:WAKE FOREST FAMILY DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DDS, OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:MANI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:919-562-7008
Mailing Address - Street 1:1900 S MAIN ST
Mailing Address - Street 2:SUITE 206
Mailing Address - City:WAKE FOREST
Mailing Address - State:NC
Mailing Address - Zip Code:27587-5026
Mailing Address - Country:US
Mailing Address - Phone:919-562-7008
Mailing Address - Fax:919-562-9809
Practice Address - Street 1:1900 S MAIN ST
Practice Address - Street 2:SUITE 206
Practice Address - City:WAKE FOREST
Practice Address - State:NC
Practice Address - Zip Code:27587-5026
Practice Address - Country:US
Practice Address - Phone:919-562-7008
Practice Address - Fax:919-562-9809
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC59771223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty