Provider Demographics
NPI:1972734176
Name:MANNING, KATHRINE I (DMD)
Entity type:Individual
Prefix:
First Name:KATHRINE
Middle Name:I
Last Name:MANNING
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9513 NE FOURTH PLAIN BLVD
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98662-6145
Mailing Address - Country:US
Mailing Address - Phone:360-254-5477
Mailing Address - Fax:360-254-4881
Practice Address - Street 1:9513 NE FOURTH PLAIN BLVD
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98662-6145
Practice Address - Country:US
Practice Address - Phone:360-254-5477
Practice Address - Fax:360-254-4881
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-05
Last Update Date:2016-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE66711223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1831267673OtherNPI