Healthcare Provider Details

I. General information

NPI: 1053353011
Provider Name (Legal Business Name): DR. DAVID MANARY
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/12/2006
Last Update Date: 07/12/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2201 N BROADWELL AVE
GRAND ISLAND NE
68803-2153
US

IV. Provider business mailing address

2201 N BROADWELL AVE
GRAND ISLAND NE
68803-2153
US

V. Phone/Fax

Practice location:
  • Phone: 308-382-3660
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number4106
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: