Basic Information
| Provider Information | |||||||||
| NPI: | 1194856955 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MANNING | ||||||||
| FirstName: | TIMOTHY | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | DMD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8309SWMAIN ST 100 | ||||||||
| Address2: | |||||||||
| City: | WILSONVILLE | ||||||||
| State: | OR | ||||||||
| PostalCode: | 970706598 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5036820550 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 3554 W GLENDALE AVE | ||||||||
| Address2: | |||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850518358 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6022335665 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/07/2007 | ||||||||
| LastUpdateDate: | 06/18/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/18/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1223G0001X | D7174 | AZ | N | Dental Providers | Dentist | General Practice | 1223G0001X | D9694 | OR | Y | Dental Providers | Dentist | General Practice | 1223G0001X | DE00010805 | WA | N | Dental Providers | Dentist | General Practice |
No ID Information.