Basic Information
| Provider Information | |||||||||
| NPI: | 1902468176 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MANNING | ||||||||
| FirstName: | EDEN | ||||||||
| MiddleName: | NETHERCUTT | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | DMD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 114 PARRISH DR | ||||||||
| Address2: | |||||||||
| City: | PIKEVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 278639300 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9197342655 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 104C ADAIR DR | ||||||||
| Address2: | |||||||||
| City: | GOLDSBORO | ||||||||
| State: | NC | ||||||||
| PostalCode: | 275304516 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9196484437 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/08/2019 | ||||||||
| LastUpdateDate: | 07/08/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 122300000X | 11524 | NC | Y | Dental Providers | Dentist |
No ID Information.