Provider Demographics
NPI:1780361816
Name:MANFRIN, ADAM ROBERT (DDS)
Entity type:Individual
Prefix:DR
First Name:ADAM
Middle Name:ROBERT
Last Name:MANFRIN
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 1:1 KNEELAND STREET
Mailing Address - Street 2:TUFTS UNIVERSITY SCHOOL OF DENTAL MEDICINE
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02111
Mailing Address - Country:US
Mailing Address - Phone:617-636-2163
Mailing Address - Fax:617-636-3851
Practice Address - Street 1:1 KNEELAND STREET
Practice Address - Street 2:TUFTS UNIVERSITY SCHOOL OF DENTAL MEDICINE
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02111
Practice Address - Country:US
Practice Address - Phone:617-636-6828
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-30
Last Update Date:2024-04-03
Deactivation Date:2024-02-02
Deactivation Code:
Reactivation Date:2024-03-19
Provider Licenses
StateLicense IDTaxonomies
MADL15732390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program