Provider Demographics
NPI:1962794008
Name:MANKER, JAMES BLAINE (DDS)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:BLAINE
Last Name:MANKER
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 1:805 N DICKINSON DRIVE
Mailing Address - Street 2:
Mailing Address - City:RUSK
Mailing Address - State:TX
Mailing Address - Zip Code:75785-0000
Mailing Address - Country:US
Mailing Address - Phone:903-683-3421
Mailing Address - Fax:903-683-7199
Practice Address - Street 1:805 N DICKINSON DRIVE
Practice Address - Street 2:
Practice Address - City:RUSK
Practice Address - State:TX
Practice Address - Zip Code:75785-0000
Practice Address - Country:US
Practice Address - Phone:903-683-3421
Practice Address - Fax:903-683-7199
Is Sole Proprietor?:No
Enumeration Date:2011-05-09
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX137731223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX13773OtherSTATE OF TEXAS LICENSED
TX13773OtherSTATE OF TEXAS LICENSED