Provider Demographics
NPI:1154612836
Name:MANNING, MARK NORMAN (DMD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:NORMAN
Last Name:MANNING
Suffix:
Gender:M
Credentials:DMD
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Mailing Address - Street 1:501 SOUTH PRESTON STREET
Mailing Address - Street 2:UNIVERSITY OF LOUISVILLE - DEPT OF ENDODONTICS
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40202-1701
Mailing Address - Country:US
Mailing Address - Phone:502-852-1318
Mailing Address - Fax:502-852-3333
Practice Address - Street 1:501 S PRESTON ST
Practice Address - Street 2:UNIVERSITY OF LOUISVILLE - DEPT OF ENDODONTICS
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202-1701
Practice Address - Country:US
Practice Address - Phone:502-852-1318
Practice Address - Fax:502-852-3333
Is Sole Proprietor?:No
Enumeration Date:2011-04-28
Last Update Date:2011-04-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KYIN PROGRESS122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist