Provider Demographics
NPI:1427263631
Name:MANN, JOHN THURMAN (DDS)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:THURMAN
Last Name:MANN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2615 DARBY DR
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:AL
Mailing Address - Zip Code:35630-1555
Mailing Address - Country:US
Mailing Address - Phone:256-766-3515
Mailing Address - Fax:256-766-3506
Practice Address - Street 1:2615 DARBY DR
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:AL
Practice Address - Zip Code:35630
Practice Address - Country:US
Practice Address - Phone:256-766-3515
Practice Address - Fax:866-288-7201
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-11
Last Update Date:2018-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL6211405241223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL000033455Medicaid