Provider Demographics
NPI:1437406022
Name:BRIAN E. MCMANUS, D.D.S., P.A.
Entity type:Organization
Organization Name:BRIAN E. MCMANUS, D.D.S., P.A.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:EMERSON
Authorized Official - Last Name:MCMANUS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:919-484-0660
Mailing Address - Street 1:8301 BRIER CREEK PKWY
Mailing Address - Street 2:SUITE 103
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27617-7326
Mailing Address - Country:US
Mailing Address - Phone:919-484-0660
Mailing Address - Fax:919-484-0030
Practice Address - Street 1:8301 BRIER CREEK PKWY
Practice Address - Street 2:SUITE 103
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27617-7326
Practice Address - Country:US
Practice Address - Phone:919-484-0660
Practice Address - Fax:919-484-0030
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-14
Last Update Date:2012-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC87831223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5912880Medicaid