Basic Information
| Provider Information | |||||||||
| NPI: | 1154612836 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MANNING | ||||||||
| FirstName: | MARK | ||||||||
| MiddleName: | NORMAN | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | D.M.D | ||||||||
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| Mailing Information | |||||||||
| Address1: | 501 SOUTH PRESTON STREET | ||||||||
| Address2: | UNIVERSITY OF LOUISVILLE - DEPT OF ENDODONTICS | ||||||||
| City: | LOUISVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 402021701 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5028521318 | ||||||||
| FaxNumber: | 5028523333 | ||||||||
| Practice Location | |||||||||
| Address1: | 501 S PRESTON ST | ||||||||
| Address2: | UNIVERSITY OF LOUISVILLE - DEPT OF ENDODONTICS | ||||||||
| City: | LOUISVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 402021701 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5028521318 | ||||||||
| FaxNumber: | 5028523333 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/28/2011 | ||||||||
| LastUpdateDate: | 04/28/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 122300000X | IN PROGRESS | KY | Y | Dental Providers | Dentist |
No ID Information.