Healthcare Provider Details

I. General information

NPI: 1295090678
Provider Name (Legal Business Name): GREGORY R MANNING DDS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/11/2012
Last Update Date: 09/08/2025
Certification Date: 09/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4365 E PECOS RD STE 132
GILBERT AZ
85295-8052
US

IV. Provider business mailing address

4365 E PECOS RD STE 132
GILBERT AZ
85295-8052
US

V. Phone/Fax

Practice location:
  • Phone: 480-988-2373
  • Fax: 480-988-2474
Mailing address:
  • Phone: 480-988-2373
  • Fax: 480-988-2474

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223X2210X
TaxonomyOrofacial Pain Dentistry
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number7453
License Number StateAZ

VIII. Authorized Official

Name: GREGORY R MANNING
Title or Position: OWNER - PROVIDER
Credential:
Phone: 480-988-2373