Provider Demographics
NPI:1831327873
Name:MANWARING, RICHARD ISAAC (DDS)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:ISAAC
Last Name:MANWARING
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 1:1186 EASTLAND DR N
Mailing Address - Street 2:SUITE B
Mailing Address - City:TWIN FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83301-8973
Mailing Address - Country:US
Mailing Address - Phone:208-733-9331
Mailing Address - Fax:208-732-1222
Practice Address - Street 1:1186 EASTLAND DR N
Practice Address - Street 2:SUITE B
Practice Address - City:TWIN FALLS
Practice Address - State:ID
Practice Address - Zip Code:83301-8973
Practice Address - Country:US
Practice Address - Phone:208-733-9331
Practice Address - Fax:208-732-1222
Is Sole Proprietor?:No
Enumeration Date:2009-06-29
Last Update Date:2018-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK117778122300000X
IDD-4666-PD1223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No122300000XDental ProvidersDentist