Healthcare Provider Details

I. General information

NPI: 1447689898
Provider Name (Legal Business Name): CHARLES ASHLEY MANN DDS PA 2
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/06/2013
Last Update Date: 11/06/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1310 FIFTH AVENUE SUITE 100
GARNER NC
27529
US

IV. Provider business mailing address

1310 FIFTH AVENUE SUITE 100
GARNER NC
27529
US

V. Phone/Fax

Practice location:
  • Phone: 919-838-7388
  • Fax: 919-443-1484
Mailing address:
  • Phone: 919-838-7388
  • Fax: 919-443-1484

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number7007
License Number StateNC

VIII. Authorized Official

Name: MS. SALLY LABRUYERE
Title or Position: PRACTICE ADMINISTRATOR
Credential:
Phone: 919-838-7388