Healthcare Provider Details

I. General information

NPI: 1306760152
Provider Name (Legal Business Name): HENRY BASS MANNING
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2026
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2280 HOGAN ST BLDG 1855
FORT CARSON CO
80913-4433
US

IV. Provider business mailing address

2280 HOGAN ST BLDG 1855
FORT CARSON CO
80913-4433
US

V. Phone/Fax

Practice location:
  • Phone: 719-526-5400
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDEN.00206766
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: