Provider Demographics
NPI:1457578189
Name:S. C. MANN DDS
Entity Type:Organization
Organization Name:S. C. MANN DDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:C
Authorized Official - Last Name:MANN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:631-475-6517
Mailing Address - Street 1:608 BLUE POINT RD
Mailing Address - Street 2:
Mailing Address - City:HOLTSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11742-1835
Mailing Address - Country:US
Mailing Address - Phone:631-475-6517
Mailing Address - Fax:
Practice Address - Street 1:608 BLUE POINT RD
Practice Address - Street 2:
Practice Address - City:HOLTSVILLE
Practice Address - State:NY
Practice Address - Zip Code:11742-1835
Practice Address - Country:US
Practice Address - Phone:631-475-6517
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY035230122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty