Provider Demographics
NPI:1174935233
Name:MANNING FAMILY DENTISTRY
Entity type:Organization
Organization Name:MANNING FAMILY DENTISTRY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETOR
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLIE
Authorized Official - Middle Name:DALLAS
Authorized Official - Last Name:MANNING
Authorized Official - Suffix:IV
Authorized Official - Credentials:DDS
Authorized Official - Phone:931-728-4143
Mailing Address - Street 1:1056 MCARTHUR ST
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:TN
Mailing Address - Zip Code:37355-2454
Mailing Address - Country:US
Mailing Address - Phone:931-728-4143
Mailing Address - Fax:931-728-8209
Practice Address - Street 1:1056 MCARTHUR ST
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:TN
Practice Address - Zip Code:37355-2454
Practice Address - Country:US
Practice Address - Phone:931-728-4143
Practice Address - Fax:931-728-8209
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-23
Last Update Date:2016-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN9694122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty