Provider Demographics
NPI:1124241641
Name:MANNING, GREGORY R (DDS PLLC)
Entity type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:R
Last Name:MANNING
Suffix:
Gender:M
Credentials:DDS PLLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4365 E PECOS RD
Mailing Address - Street 2:132
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85295-7875
Mailing Address - Country:US
Mailing Address - Phone:480-988-2373
Mailing Address - Fax:480-988-2474
Practice Address - Street 1:4365 E PECOS RD
Practice Address - Street 2:132
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85295-7875
Practice Address - Country:US
Practice Address - Phone:480-988-2373
Practice Address - Fax:480-988-2474
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-11
Last Update Date:2016-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ74531223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice